Influence of hyperglycemia and hyperuricemia on long-term transplant survival in kidney transplant recipients

Long-term prognosis in kidney transplant recipients depends on multiple fac tors. The purpose of this study was to quantify the influence of hyperurice mia and hyperglycemia (elements of the so-called 'syndrome X', i.e., a comb ination of metabolic disorders like hyperuricemia, diabetes mellitus, hyper lipidemia, and hypertension) on organ function in 350 kidney transplant rec ipients who had received 375 kidney transplants up to 1990 and in whom sex, age of recipient and donor, nephrologic disease, duration of dialysis, hum an leukocyte antigen (HLA) classification, and duration of transplant ische mia had been well matched. We found the influence of hyperuricemia on graft survival to be statistically significant (p less than or equal to 0.05), w hile a statistically significant correlation between hyperglycemia and graf t survival could not be detected in the present study. The transplant survi val rates 2, 4, and 5 yr post-kidney-transplantation were 96.7, 80.7, and 7 8.7 in normogylcemic patients vs. 96.9, 85, and 82.7% in hyperglycemic (> 1 00 mg/dL) kidney transplant recipients (p > 0.05). Transplant survival in h yperuricemic patients (male, > 8 mg/dL; female, > 6.2 mg/dL) 2, 4, and 5 yr post-transplantation was significantly reduced (92.2, 70.6, and 68.8% vs. 98.1, 85.6, and 83.3%), as compared to normouricemic recipients. A combined presence of both hyperuricemia and hyperglycemia probably influencing the prognosis post-kidney-transplantation failed to reach the level of statisti cal significance. We found a significant correlation between age of recipie nts and plasma glucose (p less than or equal to 0.01) and between serum uri c acid concentrations and diuretic therapy (p less than or equal to 0.05) a nd gender (p less than or equal to 0.05). In conclusion, hyperuricemia after kidney transplantation seems to reduce g raft survival, whereas an influence of the carbohydrate metabolism has to b e denied.