Elsevier

Transplantation Proceedings

Volume 44, Issue 9, November 2012, Pages 2585-2587
Transplantation Proceedings

2nd congress of the Spanish transplantation society
Kidney transplantation: Complications: Metabolic
New-onset Diabetes After Transplantation: Drug-Related Risk Factors

https://doi.org/10.1016/j.transproceed.2012.09.053Get rights and content

Abstract

Introduction

New-onset diabetes after transplantation (NODAT), an important complication of renal transplantation leads to reduced graft function and increased patient morbidity and mortality. Because of its high incidence and immense impact on clinical outcomes, prevention of NODAT is highly desirable. Several modifiable and nonmodifiable risk factors for NODAT have been described. The aim of this study was to analyze the influence of various drugs on the development of NODAT during the first year.

Methods

A retrospective analysis was performed on 303 adult kidney transplant recipients free of previously known diabetes. NODAT was defined as a fasting plasma glucose level ≥ 126 mg/dL confirmed by repeat testing on a different day. We excluded patients with transiently elevated fasting plasma glucose during the first 3 months.

Results

NODAT was diagnosed in 37 recipients (12.2%). Univariate analysis identified several variables related to NODAT: recipient age (P < .001), body mass index (P < .001), donor age (P = .005), family history of diabetes (P < .001), statin use (P = .005), diuretic use (P = .040) and tacrolimus therapy (P = .029). After multivariate analysis, recipient age (relative risk [RR] = 1.060, 95% confidence interval [CI] 1.019– 1.102, P = .004), family history of diabetes (RR = 3.562, 95% CI 1.574–8.058, P = .002), smoking habit (RR 2.514, 95% CI 1.118–5.655, P = .026) and diuretic use (RR = 2.496, 95% CI 1.087–5.733, P = .031) were independently associated with NODAT development.

Conclusions

In our population of kidney transplant recipients, the main nonmodifiable risk factors for NODAT were recipient age and a family history of diabetes. Diuretic use was a modifiable risk factor associated with the development of NODAT. To reduce NODAT incidence, it is necessary to consider not only immunosuppressive therapy, but also concomitant drugs such as diuretics.

Section snippets

Methods

We retrospectively analyzed kidney transplant recipients with at least 1-year posttransplantation follow-up in September 2008 and without diabetes mellitus before transplantation (n = 303). NODAT was defined as fasting plasma glucose level ≥ 126 mg/dL confirmed by repeat testing on a different day. Patients with transient elevated fasting plasma glucose during the first 3 months as well as patients who received mammalian target of rapamycin inhibitors in the first year were excluded. The

Results

A total of 37 patients (12.2%) developed NODAT in the first year after transplantation. Patients with NODAT were older and had a higher BMI at transplantation than those who did not develop diabetes. There was also an association between the occurrence of NODAT and a family history of diabetes, smoking habit, and use of tacrolimus, statins, and diuretics. There were no significant differences in gender distribution, hepatitis C, acute rejection rate, or total steroid dose between the NODAT and

Discussion

The results show that NODAT development occurred in 12.2% of transplantation patients in the first year, after exclusion of patients with transient hyperglycemia during the first 3 months. Many patients have transient abnormalities in glucose metabolism in the first months after transplantation, which may only reflect the accumulation of diabetogenic factors such as high-dose steroids and calcineurin inhibitors. Previous reports have suggested that transplantation patients with glycemic

Conclusion

In conclusion, the results of this study suggest that diuretics increase the risk of NODAT in the first year after transplant. This finding supports the importance of selecting an appropriate therapeutic regimen, considering individual's diabetic risk profile and the relative diabetogenicity of immunosuppressive and nonimmunosuppressive drugs, with particular attention to the use of diuretics in the posttransplantation period.

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