Impact of Diabetes on Physical Function Recovery following Kidney Transplantation

Background: Diabetes mellitus (DM) can impair post-operative recovery. We assess the association of DM with recovery of physical function over time among incident kidney transplant (KT) recipients using the Patient Reported Outcome Measurement Information System (PROMIS) physical function computer adaptive test (PF-CAT). Methods: Longitudinal convenience sample of incident (<30 days post-transplant) adult KT recipients recruited in 2021-2024. Demographic information was self-reported, clinical data extracted from health records. Participants completed PROMIS PF-CAT at baseline, biweekly for 3 months, and then every four weeks up to 6 months on an electronic data capture platform. PROMIS PF-CAT is scored on a T-score metric (20-80, higher scores=better physical function). Linear mixed-effect models with random intercepts were used to compare PF recovery between DM and non-DM (NDM) KT recipients. The model included the interaction between time and diabetes status, representing the average difference in PF over time, adjusting for age, sex, education, socioeconomic status, BMI and significant anxiety or depression symptoms at baseline. Individual clinically significant improvement in PF was assessed in a time-to-event analysis, with the use of log-rank tests and Cox proportional-hazards model adjusting for mentioned covariates. The primary event was defined as reaching a T-score ≥50. Results: Of 110 participants, 71(65%) were male, 62(56%) were white, 36(33%) had DM, mean(SD) age was 51(15) years and median[IQR] time since transplantation at enrollment was 4[3; 7] days. DM had significantly lower PROMIS PF over time (ref:NDM, coeff, -0.19; 95%CI, -0.33 to -0.05). At baseline, mean(SD) scores in DM(n=36) vs NDM(n=74) were 39(10) vs 39(8). At 12w, scores in DM(n=11) vs NDM(n=33) were 45(6) vs 47(6). At 24w, scores in DM(n=11) vs NDM(n=30) were 48(5) vs 51(6). The cumulative incidence of the event was 25 in NDM vs 5 in DM, p=0.02. This association remained significant after adjusting for covariates (ref: NDM, HR, 0.33; 95%CI 0.11 to 0.95, p=0.04). Conclusion: KT recipients with DM demonstrated less significant improvements in PF over 6 months compared to NDM. KT with DM may need extra support for their PF, such as prehabilitation or post-transplant rehabilitation. Funding: Private Foundation Support, Government Support – Non-U.S.