Abstract
New-onset diabetes mellitus after transplantation (NODAT) may complicate 2–50% of kidney transplantation, and it is associated with reduced graft and patient survivals. In this retrospective study, we applied a conversion protocol to sirolimus in a cohort of kidney transplant recipients with NODAT. Among 344 kidney transplant recipients, 29 patients developed a NODAT (6.6%) and continued with a reduced dose of calcineurin inhibitors (CNI) (8 patients, Group A) or were converted to sirolimus (SIR) (21 patients, Group B). NODAT resolved in 37.5% and in 80% patients in Group A and Group B, respectively. In Group A, patient and graft survivals were 100% and 75%, respectively, not significantly different from Group B (83.4% and 68%, resp., P = 0.847). Graft function improved after conversion to sirolimus therapy: serum creatinine was 1.8 ± 0.7 mg/dL at the time of conversion and 1.6 ± 0.4 mg/dL five years after conversion to sirolimus therapy (P < 0.05), while in the group of patients remaining with a reduced dose of CNI, serum creatinine was 1.7 ± 0.6 mg/dL at the time of conversion and 1.65 ± 0.6 mg/dL at five-year followup (P = 0.732). This study demonstrated that the conversion from CNI to SIR in patients could improve significantly the metabolic parameters of patients with NODAT, without increasing the risk of acute graft rejection.
Highlights
Kidney transplantation (KT) is the best available therapy for end-stage renal disease
The incidence of New-onset diabetes mellitus after transplantation (NODAT) was similar in patients treated with tacrolimus (22 patients, 7.7%) and cyclosporine (7 patients, 7%), while no patient on de novo sirolimus therapy developed post-transplant diabetes
NODAT was more common in male and in patients with polycystic kidney disease
Summary
Kidney transplantation (KT) is the best available therapy for end-stage renal disease. New-onset diabetes mellitus after transplantation (NODAT) is a well-recognized complication associated with reduction in both graft and patient survivals [1, 8, 9]. New-onset diabetes mellitus is a major risk factor for cardiovascular disease [11,12,13] and mortality [1, 8, 12,13,14,15] and is associated with reduced kidney graft survival [16, 17], infections [1, 8, 18], and increased health care costs [19]. We present the results of such study of conversion, by evaluating the rate of remission and the impact of sirolimus on the management of NODAT
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