Abstract
Modifiable and nonmodifiable risk factors for developing posttransplant diabetes mellitus (PTDM) have already been established in kidney transplant setting and impact adversely both patient and allograft survival. We analysed 450 recipients of living and deceased donor kidney transplants using current immunosuppressive regimen in the modern era and verified PTDM prevalence and risk factors over three-year posttransplant. Tacrolimus (85%), prednisone (100%), and mycophenolate (53%) were the main immunosuppressive regimen. Sixty-one recipients (13.5%) developed PTDM and remained in this condition throughout the study, whereas 74 (16.5%) recipients developed altered fasting glucose over time. Univariate analyses demonstrated that recipient age (46.2 ± 1.3vs. 40.7 ± 0.6 years old, OR 1.04; P = 0.001) and pretransplant hyperglycaemia and BMI ≥ 25 kg/m2 (32.8% vs. 21.6%, OR 0.54; P = 0.032 and 57.4% vs. 27.7%, OR 3.5; P < 0.0001, respectively) were the pretransplant variables associated with PTDM. Posttransplant transient hyperglycaemia (86.8%. 18.5%, OR 0.03; P = 0.0001), acute rejection (P = 0.021), calcium channel blockers (P = 0.014), TG/HDL (triglyceride/high-density lipoprotein cholesterol) ratio ≥ 3.5 at 1 year (P = 0.01) and at 3 years (P = 0.0001), and tacrolimus trough levels at months 1, 3, and 6 were equally predictors of PTDM. In multivariate analyses, pretransplant hyperglycaemia (P = 0.035), pretransplant BMI ≥ 25 kg/m2 (P = 0.0001), posttransplant transient hyperglycaemia (P = 0.0001), and TG/HDL ratio ≥ 3.5 at 3-year posttransplant (P = 0.003) were associated with PTDM diagnosis and maintenance over time. Early identification of risk factors associated with increased insulin resistance and decreased insulin secretion, such as pretransplant hyperglycaemia and overweight, posttransplant transient hyperglycaemia, tacrolimus trough levels, and TG/HDL ratio may be useful for risk stratification of patients to determine appropriate strategies to reduce PTDM.
Highlights
Posttransplant diabetes mellitus (PTDM) develops in 10-20% of patients after kidney transplant and is a major risk factor for cardiovascular disease and death [1]
Our study documented a PTDM cumulative incidence within three-year posttransplant of 13.5% in recipients using current immunosuppressive regimen in the modern era, which is in agreement with rates of 7.5-21% in the literature [16, 17]
Age greater than 45 years old increases PTDM risk 2.2 times when compared to individuals of 18-44 years old [20], which is in accordance to our findings
Summary
Posttransplant diabetes mellitus (PTDM) develops in 10-20% of patients after kidney transplant and is a major risk factor for cardiovascular disease and death [1]. PTDM adversely affects graft survival and increases medical costs as well [2, 3]. PTDM results from predisposing factors, to type 2 diabetes mellitus (DM), and because of specific posttransplant risk factors. Major risk factors for development of PTDM are metabolic adverse effects of immunosuppressive regimen, including calcineurin inhibitors, mammalian target of rapamycin inhibitors (mTORi), and corticosteroids, posttransplant viral infections, and hypomagnesaemia, in addition to the traditional risk factors seen in patients with type 2 DM [5,6,7,8].
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