Samarasinghe, A.Wong, G.Teixeira-Pinto, A.Johnson, D.W.Hawley, C.Pilmore, H.Mulley, W.R.Roberts, M.A.Polkinghorne, K.R.Boudville, N.Davies, C.E.Viecelli, A.K.Ooi, E.Larkins, N.G.Lok, C.Lim, W.H.2025-10-232025-10-232024CKJ: Clinical Kidney Journal, 2024; 17(3):sfad245-1-sfad245-122048-85052048-8513https://hdl.handle.net/2440/147939Background: Diabetes mellitus( DM) is associated with a greater risk of mortality in kidney transplant patients, primarily driven by a greater risk of cardiovascular disease( CVD) -related mortality. However, the associations between diabetes status at time of first allograft loss and mortality on dialysis remain unknown. Methods: All patients with failed first kidney allografts transplanted in Australia and New Zealand between 2000 and 2020 were included. The associations between diabetes status at first allograft loss, all-cause and cause-specific mortality were examined using competing risk analyses, separating patients with diabetes into those with pre-transplant DM or post-transplant diabetes mellitus( PTDM) . Results: Of 3782 patients with a median( IQR) follow-up duration of 2.7( 1.1–5.4) years, 539( 14%) and 390( 10%) patients had pre-transplant DM or developed PTDM, respectively. In the follow-up period, 1336( 35%) patients died, with 424( 32%) , 264( 20%) and 199( 15%) deaths attributed to CVD, dialysis withdrawal and infection, respectively. Compared to patients without DM, the adjusted subdistribution HRs( 95% CI) for pre-transplant DM and PTDM for all-cause mortality on dialysis were 1.47( 1.17–1.84) and 1.47( 1.23–1.76) , respectively; for CVD-related mortality were 0.81( 0.51–1.29) and 1.02 ( 0.70–1.47) , respectively; for infection-related mortality were 1.84( 1.02–3.35) and 2.70( 1.73–4.20) , respectively; and for dialysis withdrawal-related mortality were 1.71( 1.05–2.77) and 1.51( 1.02–2.22) , respectively. Conclusions: Patients with diabetes at the time of kidney allograft loss have a significant survival disadvantage, with the excess mortality risk attributed to infection and dialysis withdrawal.en© The Author(s) 2024. Published by Oxford University Press on behalf of the ERA. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/) , which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.comallograft loss; diabetes; dialysis; kidney failure; mortalityJournal article10.1093/ckj/sfad245688744Davies, C.E. [0000-0001-6595-8656]