Abstract
ObjectiveTo discuss the onset of and relevant risk factors for new-onset diabetes after a transplant (NODAT) in patients who survive more than 1 year after undergoing a renal transplant and the influence of these risk factors on complications and long-term survival.MethodA total of 428 patients who underwent a renal transplant between January 1993 and December 2008 and were not diabetic before surgery were studied. The prevalence rate of and relevant risk factors for postoperative NODAT were analyzed on the basis of fasting plasma glucose (FPG) levels, and differences in postoperative complications and survival rates between patients with and without NODAT were compared.ResultsThe patients in this study were followed up for a mean of 5.65 ± 3.68 years. In total, 87 patients (20.3%) developed NODAT. Patients who converted from treatment with CSA to FK506 had increased prevalence rates of NODAT (P <0.05). Multi-factor analysis indicated that preoperative FPG level (odds ratio [OR] = 1.48), age (OR = 1.10), body mass index (OR = 1.05), hepatitis C virus infection (OR = 2.72), and cadaveric donor kidney (OR = 1.18) were independent risk factors for NODAT (All P <0.05). Compared with the N-NODAT group, the NODAT group had higher prevalence rates (P < 0.05) of postoperative infection, hypertension, and dyslipidemia; in addition, the survival rate and survival time of the 2 groups did not significantly differ.ConclusionAmong the patients who survived more than 1 year after a renal transplant, the prevalence rate of NODAT was 20.32%. Preoperative FPG level, age, body mass index, hepatitis C virus infection, and cadaveric donor kidney were independent risk factors for NODAT. Patients who converted from treatment with CSA to FK506 after a renal transplant had aggravated impairments in glycometabolism. Patients with NODAT were also more vulnerable to postoperative complications such as infection, hypertension, and hyperlipidemia.
Highlights
Since the first renal transplant was performed in the United States in 1954, the number of renal transplant recipients has greatly increased along with the continuous promotion and maturation of the renal transplantation technique
There is evidence that novel glycometabolism and several chronic diabetic complications are improved by kidney transplantation [8,9,10,11,12], New-onset diabetes after transplantation (NODAT) severely affects the quality of life and long-term survival rate of renal transplant recipients [13,14,15,16]; NODAT is the major factor leading to dysfunction of the renal graft and patient death and is a risk factor for cardiovascular diseases in these patients [17,18,19]
After eliminating 281 of the 709 renal transplant recipients on the basis of the exclusion criteria, 428 non-diabetic patients who underwent a renal transplant for the first time and had a renal graft survival time of more than 1 year and complete data were included for analysis
Summary
Since the first renal transplant was performed in the United States in 1954, the number of renal transplant recipients has greatly increased along with the continuous promotion and maturation of the renal transplantation technique. There is evidence that novel glycometabolism and several chronic diabetic complications are improved by kidney transplantation [8,9,10,11,12], NODAT severely affects the quality of life and long-term survival rate of renal transplant recipients [13,14,15,16]; NODAT is the major factor leading to dysfunction of the renal graft and patient death and is a risk factor for cardiovascular diseases in these patients [17,18,19]. With the increasing number of patients with extended survival, the longterm influence of NODAT has been gradually emerging; in recent years, the focus of research has shifted to long-term complications and their influences on continuing human/renal survival
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