New-onset diabetes after transplantation: one point to consider.

Abstract

We read with great interest the “2003 international consensus guidelines for new-onset diabetes after transplantation” (1). Part 1.5 of these guidelines discusses the impact of new-onset diabetes as a risk factor for cardiovascular disease (CVD). It refers to the paper of Kasiske et al. (2) and claims that, “in a further study, diabetes mellitus carried the highest relative risk for ischemic heart disease (IHD) among kidney transplant patients more than 1 year posttransplant.” Later it continues, “it therefore appears that. . .the risk of CVD is also substantially higher in transplant recipients who develop diabetes after transplantation compared with those who do not develop diabetes” (2). In fact, once reviewing the original article of Kasiske et al., one finds that it does not exclusively concern the new-onset diabetes. In this retrospective study, the authors included a cohort of 1500 transplants and searched to find whether the high incidence of IHD in renal transplant recipients could be attributed to the same identified risk factors in the general population. Therefore, their study population consisted of a number of patients who presented these risk factors, including diabetes mellitus types 1 and 2, as well as a third category called “non-renal diabetes.” The latter category was defined as “diabetes that did not cause end-stage renal disease,” which is not necessarily identical to posttransplant diabetes. The authors did not refer to it as “new-onset post-transplant diabetes,” probably because that might include both the cases of new-onset diabetes after transplantation, and those existing before transplantation but not contributing to end-stage renal disease. Moreover, in the same paper, the authors have emphasized that the proportion of patients in this category was relatively small (50 out of 1124), and that the results concerning this group of patients should be interpreted cautiously. Thus, in our opinion, the results of this study cannot be used to argue for the implication of new-onset posttransplant diabetes mellitus in the higher incidence of CVD in renal transplant recipients. We believe, even months after publication, that this point should be taken into consideration because it has appeared in the international guidelines used by many readers. Didier Ducloux Amir Kazory