Comparison of post-transplantation diabetes mellitus incidence and risk factors between kidney and liver transplantation patients

Vidit N Munshi,Harini A Chakkera,Curtiss B Cook,Soroush Saghafian,K Tuesday Werner,Jose Ignacio Herrero

doi:10.1371/journal.pone.0226873

Vidit N Munshi, Harini A Chakkera + Show 4 more

Open Access

https://doi.org/10.1371/journal.pone.0226873

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Journal: PloS one	Publication Date: Jan 10, 2020
Citations: 23	License type: CC BY 4.0

Affiliation: Harvard University, Mayo Clinic, Harvard University Press

Abstract

BackgroundMost prior studies characterizing post-transplantation diabetes mellitus (PTDM) have been limited to single-cohort, single-organ studies. This retrospective study determined PTDM across organs by comparing incidence and risk factors among 346 liver and 407 kidney transplant recipients from a single center.MethodsUnivariate and multivariate regression-based analyses were conducted to determine association of various risk factors and PTDM in the two cohorts, as well as differences in glucometrics and insulin use across time points.ResultsThere was a higher incidence of PTDM among liver versus kidney transplant recipients (30% vs. 19%) at 1-year post-transplant. Liver transplant recipients demonstrated a 337% higher odds association to PTDM (OR 3.37, 95% CI (1.38–8.25), p<0.01). 1-month FBG was higher in kidney patients (135 mg/dL vs 104 mg/dL; p < .01), while 1-month insulin use was higher in liver patients (61% vs 27%, p < .01). Age, BMI, insulin use, and inpatient FBG were also significantly associated with differential PTDM risk.ConclusionsKidney and liver transplant patients have different PTDM risk profiles, both in terms of absolute PTDM risk as well as time course of risk. Management of this population should better reflect risk heterogeneity to short-term need for insulin therapy and potentially long-term outcomes.

Highlights

Health care providers face an important tradeoff in managing patients who have undergone solid organ transplantation
There was a higher incidence of post-transplantation diabetes mellitus (PTDM) among liver versus kidney transplant recipients (30% vs. 19%) at 1-year post-transplant
Liver transplant recipients demonstrated a 337% higher odds association to PTDM (OR 3.37, 95% CI (1.38–8.25), p

Summary

Introduction

Health care providers face an important tradeoff in managing patients who have undergone solid organ transplantation. The discrepancies in incidence have been attributed to changing definitions of PTDM and preferred treatment strategies over time, patient follow-up time, and presence of risk factors in available data sets, among others. For these reasons, it is likely that PTDM incidence, and by extension, its burden on the healthcare system, is being under-estimated [12]. Most prior studies characterizing post-transplantation diabetes mellitus (PTDM) have been limited to single-cohort, single-organ studies This retrospective study determined PTDM across organs by comparing incidence and risk factors among 346 liver and 407 kidney transplant recipients from a single center

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Conclusion