Risk for posttransplant diabetes mellitus with current immunosuppressive medications

Abstract

To the Editor: The risk factors and consequences of posttransplant diabetes mellitus (PTDM) were excellently reviewed by Weir and Fink1Weir MR Fink JC Risk for posttransplant diabetes mellitus with current immunosuppressive medications.Am J Kidney Dis. 1999; 34: 1-13Abstract Full Text Full Text PDF Scopus (227) Google Scholar in the July 1999 issue of the American Journal of Kidney Diseases . We appreciate the opportunity to add some supplementary information that may be of interest to the readers. It is correct that none of the referred clinical trials routinely included oral glucose tolerance tests (OGTTs) to determine the exact incidence of glycemic abnormalities in transplant recipients. However, we prospectively performed OGTTs in a large series of patients who participated in a study published 2 years ago.2Hjelmesæth J Hartmann A Kofstad J Stenstrøm J Leivestad T Egeland T Fauchald P Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age.Transplantation. 1997; 64: 979-983Google Scholar After excluding patients with pretransplant diabetes mellitus, we examined glucose intolerance in 173 consecutive kidney transplant recipients on triple immunosuppressive cyclosporine-based therapy (Sandimmune, Neoral; Sandoz/Novartis, Basel, Switzerland) by OGTT (n = 167) or the diagnosis of manifest diabetes mellitus (n = 6) 10 weeks posttransplantation, during a period of 16 months. According to the World Health Organization criteria,3Harris MI Hadden WC Knowler WC Bennett PH International criteria for the diagnosis of diabetes and impaired glucose tolerance.Diabetes Care. 1985; 8: 562-567Google Scholar the patients were divided into one of three groups, with either normal glucose tolerance, impaired glucose tolerance (IGT), or PTDM. We found a high incidence of PTDM (18%) and IGT (31%). Univariate analysis showed age, family history of diabetes, HLA-B27 phenotype, DR-mismatch, rejection, daily prednisolone dose, total methylprednisolone dose, total steroid dose, cytomegalovirus (CMV)-infection, and the use of furosemide to be associated with PTDM. Age, prednisolone dose, CMV-infection, and the use of beta-blockers were associated with IGT. Sex, body mass index, donor source, and cyclosporine level did not influence glucose tolerance. In the multivariate model, increasing prednisolone dose and age were independent predictors of both PTDM and IGT, and multivariate linear regression analysis showed a significant relationship between the 2-hour serum glucose level and prednisolone dose. Other independent predictors of PTDM were a positive family history of diabetes, CMV-infection, and HLA-B27 phenotype, whereas the use of beta-blockers was associated with IGT. To conclude, our results strongly suggest that daily prednisolone dose and recipient age are the most important determinants for the development of PTDM and IGT.