Background: Kidney transplantation is expected to modify the metabolic status. However, it remains unclear whether the transition of metabolic status before and after transplantation affects the transplant outcomes.
Methods: We analyzed 4,187 kidney transplant recipients registered in a nationwide prospective cohort from 2014 to 2020. Metabolic dysfunction (MD) was considered, if three conditions are met (body mass index, blood pressure, fasting blood glucose, triglyceride, and high-density lipoprotein cholesterol level). Patients were categorized into four groups based on the presence of MD at pretransplant and 1-year posttransplant. The primary outcome was the occurrence of death-censored graft failure and patient death.
Results: Prevalence of pre- and posttransplant MD was 49.0% and 40.1%, respectively. Among recipients without pretransplant MD, 19.6% developed MD at 1-year posttransplantation. By contrast, MD disappeared in 38.7% of the recipients with pretransplant MD. The cumulative event rate of composite of graft failure and patient death was significantly higher in both recipients with newly developed posttransplant MD and recipients with persistent MD (P<0.001). Compared to recipients without pre- and posttransplant MD, those with newly developed posttransplant MD showed an increased risk of graft failure (adjusted hazard ratio [HR], 2.50; 95% confidence interval [CI], 1.74–3.58) and those with persistent MD had higher risk of patient death (adjusted HR, 3.21; 95% CI, 1.40–7.39). The risk of composite event was increased as more metabolic components was converted to be dysfunctional after transplantation. An analysis of each component of MD showed that a normalization of blood pressure after transplantation led to a decrease in the risk of composite event.
Conclusions: Kidney transplantation significantly affects the metabolic status in patients with end-stage kidney disease. Newly developed posttransplant MD increases the risk of graft loss and persistent posttransplant MD adversely affects patient survival, suggesting that transition of metabolic status was significantly associated with kidney transplant outcomes.