Post-renal Transplantation Diabetes Mellitus - A Retrospective Study

Abstract

590 A total of 846 renal transplantations, 713 living-related (LRT) and 133 cadaveric donor (CRT), were performed at our center between October 1985 and January 1998. All patients received the same immunosuppressive drug regimen of 5 mg/kg cyclosporine, 1 mg/kg prednisolone, and 2-2.5 mg/kg azathioprine. Rejection episodes were treated with steroid pulse therapy (500 mg methylprednisolone i.v. daily for 3 days) and/or OKT3 treatment (5 mg/day). Our outpatient department routinely controls 291 of these patients. Post-transplantation diabetes mellitus (PTDM) was diagnosed in 18 (6.1%) kidney recipients who were known to be nondiabetic prior to transplantation. We performed a retrospective study of these cases looking at various parameters, including demographics and historical background, HLA typing, and laboratory findings. LRT had been performed in 15 patients and the remaining 3 had undergone CRT. The mean age of the individuals with PTDM was 34.6 years, and there were 14 male and 4 female patients. Two patients who were second-degree relatives had a family history of diabetes mellitus. Four(22.2%) of the PTDM patients required insulin treatment, while a diabetic oral diet was adequate for regulating blood glucose levels in the other 14 individuals. None of the patients received oral anti-diabetic medication. Steroid pulse treatment had been administered to 12 of the 18 (66.6%) individuals at a mean steroid dosage of 2,270.8 mg. All patients who received insulin treatment had also undergone steroid pulse therapy. Comparing the PTDM group to nondiabetic renal graft recipients, the frequency of steroid pulse treatment and dosage of steroid was higher for the PTDM group. Kidney recipients with PTDM had a mean blood glucose level of 145.8 mg/dl, serum creatinine levels for the PTDM and control groups were 1.66 mg/dl and 1.54 mg/dl, respectively (p > 0.05), and the groups' respective 5-year graft survival rates were 66.6% and 88.8% (p < 0.005). HLA groups A3 and B51 were the most frequent tissue types identified in the PTDM individuals, however, we were unable to pinpoint any specific HLA association in the patient group. In conclusion, although there were no significant differences in serum creatinine levels between the PTDM and control groups, the graft survival rate was significantly lower for those afflicted with PTDM.