Post-transplant Diabetes Mellitus in Renal Transplant Recipients-Experience in Buddhist Tzu Chi General Hospital

Abstract

Objectives: To analyze the incidence of post-transplant diabetes mellitus (PTDM) in renal transplant recipients, we evaluated the related risk factors of PTDM and clinical outcome in those patients. Materials and Methods: This study retrospectively analyzed the clinical results of 43 renal transplant recipients followed in Buddhist Tzu Chi General Hospital, which included patient demographics, type of transplant, regimen of immunosuppressant, as well as the development of acute allograft rejection, cytomegalovirus infection (CMV), and PTDM. The incidence, management and risk factors of PTDM were determined. A multivariate analysis of the risk factors of PTDM, which included age at transplantation, family history of diabetes, acute allograft rejection, CMV infection and regimen of immunosuppressant, was performed using logistic regression analysis. Results: The incidence of PTDM was 20.9%. In terms of risk factors analysis for PTDM, there were five patients aged over 45 years, and one patient had family history of diabetes. Four patients were diagnosed with acute allograft rejection and three patients had CMV infection. In the multivariate analysis, only the patients with CMV infection had a higher incidence of PTDM compared with those without CMV infection (odds ratio (OR)=9.56; P=0.04). Although there was a trend for developing PTDM in patients using tacrolimus-based immunosuppressants, it was statistically not significant when the data were compared with those using cyclosporine-based regimens (OR=7.30; P=0.06). Importantly, the PTDM patients who used tacrolimus-based immunosuppressants all had high trough levels of serum tacrolimus (＞15ng/mL) when PTDM was diagnosed. In regard to the initial management of PTDM, four recipients took insulin to control their blood glucose and three took oral hypoglycemic agents (OHA). The blood glucose was controlled simply by diet and reducing dosage of immunosuppressants in two patients. None of the PTDM patients were insulin-dependent after the initial treatment. Conclusions: The pre-transplant evaluation of patients' risk factors, the choice and adjustment of immunosuppressants, scheduled monitoring of blood glucose level after renal transplantation and prompt treatment of hyperglycemia showed promise in decreasing the incidence and severity of PTDM in renal transplant recipients.