Low Incidence of New Onset Diabetes Mellitus After Renal Transplantation Under Low-Dose Tacrolimus-Based Immunosuppression: A Single Center Experience.

Abstract

Introduction:New onset diabetes mellitus after transplantation (NODAT) is a common metabolic complication after renal transplantation, and its incidence varies depending on definition of diagnosis of NODAT, patient group (ethnicity), and immunosuppressive regimen. NODAT could be a cause of poor graft outcomes including infectious complications and poor graft function. We have employed low-dose tacrolimus immunosuppression with low-levels of tacrolimus trough after transplantation. We assessed the incidence of NODAT under low-dose tacrolimus immunosuppression and examined the association between NODAT and graft function after renal transplantation. Patients and Methods:Eight hundred seventy-four renal transplants were carried out at our institution between 1998 and 2013, and all of them were treated with tacrolimus-based immunosuppression. Out of 874, 115 were excluded from this study because they had diabetes mellitus preoperatively -- so called diabetic nephropathy patients. Eight hundred seventy-four patients were enrolled in this retrospective study. All patients had their FBS and HbA1c examined after renal transplantation every 3-6 months. Induction phase, tacrolimus trough levels were 6-10ng/ml and 3-5ng/ml in the maintenance phase. We started treatment by modification of lifestyle and/or antidiabetic medication once NODAT was diagnosed after transplantation. We analyzed the clinical characteristics of recipients, and long-term patient and graft survival. Results:The overall incidence of NODAT was 4.5% (n = 34). Sixteen patients were treated with insulin injection (2%) and 9 patients were on medical treatment. Nine patients were on diet therapy alone. The 10-year patient survival of NODAT and non-NODAT recipients was 79.8% and 97.9%, respectively, and was not significant between two groups. The 10-year graft survival of NODAT and non-NODAT recipients was 73.7% and 89.4%, respectively, and was significant between two groups (p=0.04). Both the tacrolimus dose and trough levels were not different between the two groups at most time points after kidney transplantation. Conclusions:The incidence of NODAT was 4.5% and was low under low-dose tacrolimus immunosuppression. NODAT did not negatively affect patient survival under low-dose tacrolimus immunosuppression, although the graft survival was slightly poorer in NODAT patients than non-NODAT patients.