Functional and Histopathologic Changes in Renal Transplant Patients With New-Onset Diabetes and Dyslipidemia

Abstract

Background The principal risk factors for cardiovascular mortality posttransplantation are hyperglycemia, hypertriglyceridemia, obesity, and smoking. Methods Among 115 patients, we assessed the risk factors for new-onset diabetes (NODM) and dyslipidemia (NODL), and their effects on the function and histopathologic changes in the allografts at 1 year posttransplantation. Results When evaluating the risk factors and the initial recipient data, we observed a significant difference in age when comparing normal vs NODM patients ( P = .004), normal versus NODL patients ( P = .002), and normal versus NODL + NODM patients ( P = .0001). The difference in body mass index (BMI) was significant when comparing normal with NODM + NODL patients ( P = .003). In regard to immunosuppressive therapy, NODM was significantly more frequent among/prescribed tacrolimus (tac; P = .005), whereas subjects who received cyclosporine (CsA) showed a significantly higher incidence of NODL ( P = .001). The triglyceride levels were 3.02 ± 1.51 mmol/L among those on CsA versus 2.15 ± 1.57 mmol/L for ( P = .004). The difference also proved to be significant for total cholesterol level: 5.43 ± 1.23 mmol/L versus 4.42 ± 1.31 mmol/L respectively ( P = .001). In regard to allograft function a significant difference was noted at 1 year after transplantation between the NODM + NODL and the normal group in serum creatinine level ( P = .02) as well as the estimated glomerular filtration rate ( P = .004). Among diabetic patients, the serum creatinine level measured at posttransplant year 5 was significantly higher than that in 1 year (212.43 vs 147.00 μmol/L; P = .0003). When assessing morphologic changes in the kidney, we observed significantly more frequent interstitial fibrosis/tubular atrophy in all 3 groups compared with normal function patients. Conclusion Our clinical study suggested that at 1 year after transplantation allograft function is already impaired in the presence of both medical conditions (NODM and NODL). However, in regard to morphology, a single condition (NODM or NODL) was sufficient to produce histologic changes in the kidney.