2nd congress of the Spanish transplantation societyKidney transplantation: Complications: MetabolicNew-onset Diabetes After Transplantation: Drug-Related Risk Factors
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.
References (9)
- et al.
Diabetes mellitus after kidney transplantation in the United States
Am J Transplant
(2003) - et al.
New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation
Kidney Int
(2005) - et al.
Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years
Kidney Int
(2001) - et al.
Early pulse pressure and low grade proteinuria as independent long-term risk factors for new-onset diabetes after kidney transplantation
Am J Transplant
(2008)