PSUN273 Endocrine Management of Renal Transplant Patients: A Role in Successful Graft Survival? Updated Data

Abstract

Abstract Introduction Graft survival after renal transplantation is dependent upon multiple factors. Many patients undergoing renal transplantation have endocrine disorders, such as pre-existing diabetes and metabolic bone disease, and can develop post-transplant diabetes (PTDM) and hyperlipidemia. Diabetes, lipid abnormalities, and hypovitaminosis D have been associated negatively with patient and graft survival1, 2. Our kidney transplant program ranks among the top 3 programs in the country for its kidney transplant outcomes according to the data by the Scientific Registry of Transplant Recipients. We hypothesized that our multidisciplinary team management of these patients was one factor in this success. We reported our findings in 2017. Here we present follow up data through 2021 on this same cohort. Methods Over 20 years ago members of the Endocrine division began attending the transplant clinic in the Department of Surgery to facilitate patient care. In 2016 we identified all patients followed over the previous 3 years. Charts were reviewed after IRB approval and data collected retrospectively. Data for this cohort has been updated through 2021. Results A total of 241 patients were seen (of 626 total transplant recipients). There were 154 males, 87 females, and the average age at transplant was 47 years. Diabetes was present prior to transplant in 118 (46.6%) and an additional 51 (21%) developed PTDM. For patients with diabetes, the pre transplant A1c fell from 7.5 ± 1.6% to 7 ± 1.2% at 6 months (p = 0.13). At 6 months, the A1c was 6.45% for those who had developed PTDM. Pre-transplant, 79 (31%) were on some form of lipid lowering therapy. Post-transplant, 216 (90%) had hyperlipidemia: 186 (77%) were on a statin, in addition to 51(21%) on fish oil, 28 (12%) on gemfibrozil, and 4 (1.5%) on niacin. The average Vitamin D level within 1 year post-transplant was 19.9 ± 8, but increased to 33± 14 at most recent visits (P < .01). Of 217 patients over the age of 40, 93 (43%) have had a DEXA: Osteoporosis was diagnosed in 43 patients and osteopenia in an additional 31. Of these patients, 34 are or have been on treatment (bisphosphonate). Conclusions We believe that multidisciplinary team management of post renal transplant patients can improve graft survival. While our improvement in A1c values at 6 months post-transplant was not statistically significant, the trend was clearly there even considering potential artefactual lowering of the A1c in renal failure patients. We did demonstrate improvement in Vitamin D levels and frequency of statin use. We also found that there remain some barriers for care (evidence, for example, by many patients not having Vitamin D levels or DEXA). Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.