Renal transplant among type 1 and type 2 diabetes patients in Spain: A population-based study from 2002 to 2013

•Rates of renal transplant increased in type 2 diabetes patients over time.•Time trend analyses 2002-2013 showed increases in infections and rejection.•Infection rates were higher in people with T2DM/T1DM than in non-diabetic people.•We observed decreasing mortality rates during admission for renal transplant.•Diabetes was not associated with a higher in-hospital mortality.

BackgroundTo describe trends in the rates and short-term outcomes of renal transplants (RTx) among patients with or without diabetes in Spain (2002-2013).MethodsWe used national hospital discharge data to select all hospital admissions for RTx. We divided the study period into four three-year periods. Rates were calculated stratified by diabetes status: type 1 diabetes (T1DM), type 2 diabetes (T2DM) and no-diabetes. We analyzed Charlson comorbidity index (CCI), post-transplant infections, in-hospital complications of RTx, rejection, in-hospital mortality and length of hospital stay.FindingsWe identified 25,542 RTx. Rates of RTx increased significantly in T2DM patients over time (from 9.3 cases/100,000 in 2002/2004 to 13.3 cases/100,000 in 2011/2013), with higher rates among people with T2DM for all time periods. T2DM patients were older and had higher CCI values than T1DM and non-diabetic patients (CCI ≥ 1, 31.4%, 20.4% and 21.5%, respectively; P < 0.05). Time trend analyses showed significant increases in infections, RTx-associated complications and rejection for all groups (all P values < 0.05). Infection rates were greater in people with T2DM (20.8%) and T1DM (23.5%) than in non-diabetic people (18.7%; P < 0.05). Time trend analyses (2002-2013) showed significant decreases in mortality during admission for RTx (OR 0.75, 95% CI 0.68-0.83). Diabetes was not associated with a higher in-hospital mortality (OR: 1.20, 95% CI 0.92-1.55).InterpretationRTx rates were higher and increased over time at a higher rate among T2DM patients. Mortality decreased over time in all groups. Diabetes does not predict mortality during admission for RTx.FundingInstituto Salud Carlos III and URJC-Banco Santander.