New-onset Diabetes After Transplantation Group Research Articles

Neutrophil: Lymphocyte and Platelet: Lymphocyte ratios measured before transplantation and their correlation with new-onset diabetes post-transplantation in renal transplant recipients

PurposeOur goal was to evaluate the neutrophil:lymphocyte (NLR) and platelet:lymphocyte (PLR) ratios measured before transplantation and their correlation with new-onset diabetes after transplantation (NODAT) in renal transplant recipients. Patients and methodsWe conducted our study in 324 adult patients consecutively admitted to Military Hospital 103, Ha Noi, Viet Nam, who received kidney allografts from living donors. These patients were followed-up during the first 2 years post-transplantation for NODAT. We examined the association between NLR and PLR measured prior to transplantation in patients with NODAT: NLR and PLR were calculated based on the results of the complete blood count. The criteria for diagnosis of a fully symptomatic NODAT case were based on the guidelines established by the American Diabetes Association and included fasting venous blood glucose and glycosylated hemoglobin A1c (HbA1c) levels, with or without an oral glucose tolerance test. ResultsThe overall rate of NODAT during the two years after kidney transplantation was 13.6%. We found mean values of age and body mass index (BMI), and median values of NLR, PLR, high sensitivity C-reactive protein (hs-CRP) levels, and the arteriosclerosis ratio in the NODAT group to be significantly higher than those of the non-NODAT group (all p < 0.05). Furthermore, an adjusted multivariate regression analysis showed that age (area under the curve [AUC] = 0.727, p < 0.001), BMI (AUC = 0.846, p < 0.001), serum hs-CRP levels (AUC = 0.884, p < 0.001), NLR (AUC = 0.888; p < 0.001), and PLR (AUC = 0.818; p < 0.001) had predictive value for NODAT. ConclusionNLR and PLR measured before transplantation were good predictors for NODAT in the first 2 years post-renal transplantation.

New-Onset Diabetes after Transplantation (NODAT) in Renal Transplant Recipients, A Retrospective Single Centre Study

Objective: New onset diabetes after transplant (NODAT) is a known post-transplant complication contributing to morbidity and mortality. This study was aimed to find out the frequency of NODAT in kidney disease patients after one year. Methods and subjects: The study was conducted retrospectively on 275 Asian patients who underwent kidney transplant. The demographic and clinical data was evaluated at the time, as well as 3, 6, and 12 months after kidney transplant. The etiology of end-stage renal disease (ESRD) or comorbidities was also documented. Every patient received a combination of Tacrolimus (Tac), Mycophenolate Mofetil (MMF), and Prednisone (Pred) as post-transplant immunosuppression. Patients who developed NODAT were compared with those who did not. RESULTS: One year after the transplantation, the incidence of NODAT was 4.3 percent. Patients diagnosed with NODAT were older (p = 0.001) and had renal failure owing to Chronic glomerulonephritis with hypertension (p = 0.001), according to the results of the univariate analysis. The NODAT group had significantly greater rates of high blood pressure after transplantation (p = 0.01), heart failure (p = 0.02), and dyslipidemia (p = 0.001) than the other groups. Through the use of logistic regression, it was shown that high blood pressure after transplant, and dyslipidemia are all independently linked with NODAT. Conclusion: Asian patients who had high blood pressure and dyslipidemia had a higher incidence of NODAT compared to those who did not have. Keywords: kidney transplantation, prevalence, new-onset diabetes after trasplant

Risk of New-Onset Diabetes after Transplantation among Kidney Transplant Recipients with Cytomegalovirus Infection: A Retrospective Analysis

Background: New-onset diabetes after transplantation (NODAT) is one of the common complications reported in patients with kidney transplant and is associated with risk of infection, poor allograft and patient survival. There is conflicting research literature regarding the role of cytomegalovirus (CMV) infection in increasing the risk of NODAT development. Objective: To assess the risk of development of NODAT in kidney transplant patients with CMV infection Methods: A total of 59 kidney transplant patients were studied from March 2017 to February 2019. NODAT was defined as two readings of fasting plasma glucose of ≥126 mg/dL at three months post-transplant. CMV viral load was also documented. The 12 months post-transplant allograft and patient survival outcomes were also measured. Results: Mean age was 43.4 ± 6.2 years. Nearly one-fourth, 14 (23.7%), of the patients had NODAT. CMV viral load and viremia were high in NODAT group; however, the result did not reach statistical significance. CMV DNA replication was statistically high during 1-6 months post-transplant for NODAT group (P&lt;0.001). Only 7 (11.9%) recipients advanced to symptomatic CMV infection. Also, we found that high CMV viremia load was associated with poor kidney allograft function at 12 months. Conclusions: In summary, this study showed that infection with CMV may not be a risk factor to develop NODAT in patients transplanted with kidney. An elevated CMV viral load may decrease the post-transplant allograft function at 12 months. The prompt diagnosis and timely management of CMV infection could substantially lessen the risk to develop NODAT subsequent worsening of allograft and patient survival. Keywords: Kidney; Transplant; NODAT; New-onset Diabetes; Cytomegalovirus

Association of serum adiponectin and leptin levels with renal function in kidney transplant recipients with or without new-onset diabetes after transplantation.

PurposeTo evaluate serum adiponectin and leptin concentration in new‐onset diabetes after transplantation (NODAT) and non‐NODAT patients and association with renal function in kidney transplant recipients (KTRs).Patients and methodsA study of 314 consecutive adults KTRs divided into four groups: 236 individuals without NODAT who had renal insufficiency (RI; n = 56) or normal renal function (n = 180) and 78 patients with NODAT who had RI (n = 17) or normal renal function (n = 61). NODAT was diagnosed based on venous fasting blood glucose or HbA1c with the criteria of the American Diabetes Association. Renal insufficiency was defined according to KDOQI 2002 guidelines.ResultsIn the NODAT group, the median level of serum adiponectin was lower than that of non‐NODAT one (30 µg/ml vs 37.15 µg/ml, p < 0.001); in contrast, the median leptin concentration was higher (4.27 ng/ml vs 4.05 ng/ml, p = 0.024). In the RI group, both median serum adiponectin and leptin levels were higher than those of non‐RI one (Adiponectin: 40.01 µg/ml vs 33.7 µg/ml; Leptin: 4.51 ng/ml vs 3.91 ng/ml, p < 0.001 both). We found that BMI was related to both adiponectin and leptin levels in both NODAT, non‐NODAT, and all subject groups, based on univariate and multivariate linear regression analysis.ConclusionNew‐onset diabetes after transplantation, BMI, and renal insufficiency were affected to the serum level of adiponectin and leptin in KTRs.

Serum hs-CRP measured prior transplantation predicts of new-onset diabetes after transplantation in renal transplant recipients

BackgroundTo assess the incidence of new-onset diabetes after transplantation (NODAT) for the first year post-transplantation and the predictive value of high-sensitivity C-reactive Protein (hs-CRP) before transplantation for NODAT prediction in kidney transplantation patients. Material and methodsA study of 251 consecutive adult end-stage kidney disease patients transplanted kidneys from living donors, follow-up during the first year to find NODAT. We diagnosed NODAT based on blood glucose or HbA1c following to the criteria of the American Diabetes Association. ResultsThe ratio of NODAT was 12.4%. The mean age, mean BMI, the proportion of arteriosclerosis, and the median hs-CRP level in NODAT group were significantly higher than those of non-NODAT group with p < 0.05. Age, BMI and serum hs-CRP had a predictive value for NODAT (Age: AUC = 0.62, p < 0.05, BMI: AUC = 0.626, hs-CRP: AUC = 0.748, p < 0.001). ConclusionSerum hs-CRP level measured prior transplantation is a good predictor for NODAT in renal transplant recipients.

Predictive Value of Triglyceride Glucose Index for the Development of New-Onset Diabetes Mellitus Following Heart Transplantation

<h3>Purpose</h3> Diabetes mellitus (DM) is a major cause of morbidity and mortality following heart transplantation (HT), with 35% being affected within 5 years. Identification of patients at risk for the development of DM could enable prevention and proper intervention. The Triglyceride Glucose (TyG) index is considered a surrogate marker of insulin resistance and is an early indicator for developing type 2 DM in the non-transplant population. We investigated the association between the TyG index and new-onset diabetes after transplantation (NODAT). <h3>Methods</h3> A total of 158 non-DM HT patients were included in the study. The risk of NODAT was assessed according to the 3-month TyG index, calculated as ln[fasting triglycerides (mg/dL) × fasting plasma glucose (mg/dL)/2]. The endpoint was NODAT, defined according to the diagnostic criteria of the American Diabetes Association. <h3>Results</h3> The overall prevalence of NODAT was 20%. The TyG index in the NODAT group was significantly higher than that for the no-NODAT group (9.4 vs 8.7, p <0.001). A TyG index of 8.9 had a sensitivity of 78%, with a specificity of 70% for the prediction of NODAT. Kaplan-Meier survival analysis showed that NODAT rate was significantly higher for patients with a high vs a low TyG index (40 vs 8%, p >0.001, Fig.). Consistently, multivariable analysis, adjusted for age, gender, BMI, immunosuppression, hypertension, and dyslipidemia, showed that a high TyG index was independently associated with a significant 3.3-fold increased risk for NODAT (p = 0.03, Fig.). Patients with a high TyG index had significantly higher rates of peripheral vascular disease (21 vs 8%, p = 0.04) and allograft vasculopathy (48 vs 19%, p <0.001) than patients with a low TyG index. <h3>Conclusion</h3> The TyG index, a simple measure reflecting insulin resistance, might help identify individuals at high risk for developing NODAT. The implications of early interventions, using the TyG index as a marker, on the risk for NODAT and clinical outcomes, should be evaluated.

Immunosuppressive therapy as a risk factor for new-onset diabetes after transplantation

To analyze the modes of immunosuppressive therapy as a risk factor for new-onset diabetes after transplantation (NODAT) in kidney recipients. The retrospective analysis included data from 1367 recipients (755 men and 612 women) who lived more than one year after NODAT and were observed at the Moscow City Nephrology Center from January 1989 to December 2018. NODAT was established for 178 (13%) patients based on criteria from the World Health Organization and the American Diabetes Association. The modes of immunosuppressive therapy using cyclosporin A (CSA), tacrolimus (Tac), mTOR inhibitors, glucocorticoids in patients with NODAT and without NODAT were evaluated. To assess the impact of risk factors, descriptive statistics methods were used, the odds ratio (OR) and the 95% confidence interval (CI) were calculated. NODAT was diagnosed in 105 men and 73 women. The OR for men was 1.19 (95% CI 0.871.64), the OR for women was 0.84 (95% CI 0.611.15). At the time of transplantation, the average age of the kidney recipients in the NODAT group was higher than in the group without NODAT: 51 [43; 57] and 43 [32; 52] years, respectively (p=0.0001). Most patients with NODAT (82%) were older than 50 years, while in the group without NODAT, the proportion of patients of the same age was 48.5% (p=0.0001). Among patients without NODAT, transplantation of a kidney from a living donor was significantly more often compared with the group with NODAT+ (7.1% vs 1.1%;p=0.001). Among the recipients who received the regimen with CSA, diabetes developed in 75 (42.1%), those who received Tac in 102 (57.3%;p0.05). The chance (risk of development) of NODAT in patients receiving i-mTOR + Tac was 3.2 (95% CI 1.476.78;p=0.032), and for patients receiving i-mTOR + cyclosporin A, the chance of development NODAT was 1.95 (95% CI 0.884.35;p=0.044). 13% of recipients developed de novo kidney diabetes after allograft. Age at the time of allotransplantation, gender, as well as the use of tacrolimus in combination with i-mTOR are the most significant risk factors for the development of NODAT.

Incidence of New-Onset Diabetes and PostTransplant Metabolic Syndrome after Liver Transplantation - A Prospective Study from South India.

Background and Aims:Liver transplantation has become an effective therapy for patients with end-stage liver disease. The risk of new-onset diabetes after transplantation (NODAT) and posttransplant metabolic syndrome (PTMS) is high among patients after liver transplantation. These are thought to be associated with increased risks of graft rejection, infection, cardiovascular disease, and death. Our study aimed to document the incidence of NODAT and PTMS and analyze pre and posttransplant predictive factors for their development in patients undergoing a liver transplant.Methods:This was a prospective comparative study on 51 patients who underwent live donor liver transplantation. They were evaluated at baseline, 3 and 6 months after transplantation with fasting glucose, lipids, serum insulin levels, C-peptide, and HbA1C. They were followed up at 5 years to document any cardiovascular events or rejection.Results:The incidence of preoperative diabetes mellitus (DM) in the study group was 25/51 (49%). The incidence of NODAT was 38.5% (10/26 patients) and PTMS 29% (10/35), respectively. Age (47.7 ± 5.4 vs 41.5 ± 12.7 years), HOMA2 - IR (2.3 ± 1.8 vs 2.1 ± 1.6), serum insulin (16.1 ± 12.0 vs 17.9 ± 14.5), and C-peptide (4.6 ± 0.5 vs 4.8 ± 0.7) were similar at baseline in the NODAT group compared to those who did not develop it. Mean tacrolimus levels were higher in PTMS group (6.8 ± 2.9 vs 5.0. ± 2.0 P value = 0.042). By the end of 5 years, 7 patients expired; 6 due to rejection and one due to cardiovascular disease. Moreover, 2 of these patients had preexisting DM and 2 had NODAT.Conclusions:None of the baseline metabolic factors in patients undergoing liver transplant were predictive of the development of NODAT or PTMS. Mean tacrolimus levels were significantly higher in the PTMS group. A 5-year follow-up showed no excess risk of cardiovascular events or rejection in those with preexisting DM or in those who developed NODAT.

New-onset diabetes after kidney transplantation: Incidence and associated factors.

AIMTo determine the incidence and associated factors of new-onset diabetes after transplantation (NODAT) in a Portuguese central hospital.METHODSThis single-center retrospective study involved consecutive adult nondiabetic transplant recipients, who had undergone kidney transplantation between January 2012 and March 2016. NODAT was diagnosed according to the criteria of the American Diabetes Association. Data were collected from an institutional database of the Nephrology and Kidney Transplantation Department (Santa Maria Hospital, Lisbon, Portugal) and augmented with data of laboratorial parameters collected from the corresponding patient electronic medical records. Exclusion criteria were preexisting diabetes mellitus, missing information and follow-up period of less than 12 mo. Data on demographic and clinical characteristics as well as anthropometric and laboratorial parameters were also collected. Patients were divided into two groups: With and without NODAT - for statistical comparison.RESULTSA total of 156 patients received kidney transplant during the study period, 125 of who were included in our analysis. NODAT was identified in 27.2% of the patients (n = 34; 53% female; mean age: 49.5 ± 10.8 years; median follow-up: 36.4 ± 2.5 mo). The incidence in the first year was 24.8%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation, and 76.5% of the patients developed NODAT in the first 3 mo. In the group that did not develop NODAT (n = 91), 47% were female, with mean age of 46.4 ± 13.5 years and median follow-up of 35.5 ± 1.6 mo. In the NODAT group, the pretransplant fasting plasma glucose (FPG) levels were significantly higher [101 (96.1-105.7) mg/dL vs 92 (91.4-95.8) mg/dL, P = 0.007] and pretransplant impaired fasting glucose (IFG) was significantly more frequent (51.5% vs 27.7%, P = 0.01). Higher pretransplant FPG levels and pretransplant IFG were found to be predictive risk factors for NODAT development [odds ratio (OR): 1.059, P = 0.003; OR: 2.772, P = 0.017, respectively].CONCLUSIONNODAT incidence was high in our renal transplant recipients, particularly in the first 3 mo posttransplant, and higher pretransplant FPG level and IFG were risk factors.

Body mass index before kidney transplantation — principal risk factor for NODAT

Purpose. Pretransplant obesity is a well-known risk factor for post-transplant outcomes such as patient and graft survival, delayed graft function, rejection, and wound complications. According to the recommendations of the European Renal Best Practice, patients who have body mass index (BMI) value of more than 30 kg/m2 before kidney transplantation should reduce their weight. Materials and methods. In the group of 297 patients who had undergone primary kidney transplantation from post-mortem donors, we found that assessed the impact of BMI on the development of new onset diabetes after transplantation (NODAT). Additionally, relationships between immunosuppression, weight gain and BMI in patients after kidney transplantation were also analysed. We measured the value of the patients’ BMI and weight before kidney transplantation, 12 months after kidney transplantation, and 5 years after kidney transplantation. The group contained only those patients who, at the time of the kidney transplantation, did not suffer from diabetes mellitus. According to the development of NODAT in the monitored period, the group of patients was divided into the control group and NODAT group. We detected analysed the data on the type of immunosuppression (tacrolimus, cyclosporine A, mTOR inhibitor) and the average levels in the monitored period and identified whether BMI or increased weight 12 months and 5 years after kidney transplantation is related to the level (or dose) of the used immunosuppression. Results. In our group, the patients who developed NODAT in the post-transplant period were significantly older in the 12-month analysis (p < 0.0001) and also in the 5-year analysis (p = 0.0001); had higher BMI at the time of transplantation (p = 0.0003) and higher BMI 12 months after kidney transplantation (p = 0.0004) and a significantly higher weight gain 12 months after kidney transplantation (p = 0.0469). We discovered that neither the level of immunosuppression nor the dose of prednisone had any effect on the increase in BMI or weight gain during the monitored period. Conclusion. The patients in the waiting list, who have any risk factors for the development of diabetes mellitus, should be informed how to eliminate these risk factors (weight control, diet, physical exercises, etc.). In addition to the above, all candidates for kidney transplantation are recommended to stop smoking, to control blood pressure, and perform a lipidogram.

Effect of Transient Post-transplantation Hyperglycemia on the Development of Diabetes Mellitus and Transplantation Outcomes in Kidney Transplant Recipients

BackgroundHyperglycemia occurs frequently after kidney transplantation and may be reversed when the dosage of the immunosuppressive agents is tapered. However, the effect of transient post-transplantation hyperglycemia (PTH) on transplantation outcomes is not well described. MethodsKidney transplant recipients without diabetes who underwent kidney transplantation between 2001 and 2012 were enrolled in the study. Transient PTH was defined as recovery from PTH without further antidiabetic therapy and the maintenance of glycated hemoglobin levels <6.5% at 1 year after transplantation. Persistent PTH until 1 year after transplantation was considered to be new-onset diabetes after transplantation (NODAT). The factors associated with increased risk of PTH were analyzed. We compared the development of diabetes mellitus, cardiovascular disease, and other transplantation outcomes among patients with no PTH, transient PTH, and NODAT. ResultsAmong 176 kidney transplant recipients, 106 (60.2%) developed PTH and 58 (54.7%) of 106 patients with PTH had transient PTH. Older age, high body mass index (BMI), and female gender were independent risk factors for transient PTH. The incidence of diabetes was not significantly different between patients with no PTH and those with transient PTH. The incidence of cardiovascular disease was significantly increased in NODAT group compared with that in no PTH and transient PTH groups. However, the incidences of acute rejection, allograft loss, and patient death were comparable among the three groups. ConclusionsTransient hyperglycemia after kidney transplantation was found to be associated with older age, high body mass index, and female gender. Transient elevation of blood glucose level did not affect post-transplantation outcomes, including diabetes mellitus and cardiovascular disease. However, patients with NODAT should be carefully monitored for the occurrence of cardiovascular disease.

New‐onset diabetes after liver transplantation and its impact on complications and patient survival

The aim of the present study was to investigate the incidence and risk factors of new-onset diabetes after transplantation (NODAT) in liver transplant recipients and the influence of NODAT on complications and long-term patient survival. We examined 438 patients who underwent liver transplantation between April 2001 and December 2008 and were not diabetic before transplantation. The mean (± SD) follow-up duration was 2.46 ± 1.62 years. The incidence of NODAT 3, 6, 9, 12, 36, and 60 months after transplantation was 44.24%, 25.59%, 23.08%, 25.17%, 17.86%, and 18.18%, respectively. Multifactor analysis indicated that preoperative fasting plasma glucose (FPG) levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an interleukin-2 receptor (IL-2R) antagonist reduced the risk of NODAT. Compared with the no NODAT group (N-NODAT), the NODAT group had a higher rate of sepsis and chronic renal insufficiency. Mean survival was significantly longer in the N-NODAT than NODAT group. Cox regression analysis showed that pre- and/or postoperative FPG levels, tumor recurrence or metastasis, and renal insufficiency after liver transplantation were independent risk factors of mortality. Pulmonary infection or multisystem failure were specific causes of death in the NODAT group, whereas patients in both groups died primarily from tumor relapse or metastasis. Preoperative FPG levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an IL-2R antagonist reduced the risk of NODAT. Patients with NODAT had reduced survival and an increased incidence of sepsis and chronic renal insufficiency. Significant causes of death in the NODAT group were pulmonary infection and multisystem failure.

Association between E23K variant in KCNJ11 gene and new-onset diabetes after liver transplantation.

New-onset diabetes after transplantation (NODAT) is an important complication after solid organ transplantation. NODAT is a polygenic disease and KCNJ11 E23K polymorphism is considered as a diabetes-susceptibility gene. The present study aimed to assess the association between KCNJ11 (rs5219) variants and the risk of developing NODAT after liver transplantation. This study was conducted on 120 liver transplant recipients who had received tacrolimus-based immunosuppressive drugs. The liver transplant recipients were divided into an new onset diabetes mellitus (NODM) and a non-NODM group. The NODAT group consisted of 60 patients who developed diabetes in the first 6 months after transplantation, while the non-NODAT group included 60 patients who remained euglycemic. The patients were genotyped using polymerase chain reaction-restriction fragment length polymorphism and the incidence of NODAT was compared between the two groups. Nongenetic risk factors including donor gender and cold ischemia time, and recipient (MELD score, presence of viral hepatitis, acute rejection and steroid pulse therapy) were also considered. The KCNJ11 KK variant was associated with an increased risk for NODAT with respective odds ratio of 6.03 (95 % confidence interval 2.37-15.4; P < 0.001]. Donor age and male sex, recipient age as well as fasting plasma glucose before transplantation were significantly different between NODAT and non-NODAT groups (P < 0.05). The prednisolone daily dosage was significantly higher in the NODAT group (P = 0.01). These patients received pulse of methyl prednisolone for treatment of acute rejection. This study showed that polymorphisms in KCNJ11 might predispose the patients treated by tacrolimus to development of NODAT after liver transplantation.

Mitochondrial DNA haplogroups and risk of new-onset diabetes among tacrolimus-treated renal transplanted patients

Background and aimsTacrolimus (Tac) is an immunosuppressive drug widely used to avoid organ rejection. New-onset diabetes after transplantation (NODAT) is a major complication among transplanted patients who receive Tac. The increased risk for NODAT could be partly mediated by the effect of Tac on mitochondria from pancreatic beta-cells. Common and rare mitochondrial DNA variants have been linked to the risk of diabetes. Our aim was to determine whether mtDNA polymorphisms/haplogroups were associated with NODAT in Tac-treated kidney transplanted. MethodsSeven polymorphisms that define the common European haplogroups were determined in 115 NODAT and 197 no-NODAT patients. ResultsHaplogroup H was significantly more frequent in the NODAT group (50% vs. 35%; p=0.01, OR=1.82). There was no difference between patients without and with (n=106) D2M prior to the transplant. ConclusionsMitochondrial haplogroup H was associated with the risk for NODAT among Tac-treated transplanted patients. The reported differences between the mtDNA variants could explain the increased NODAT-risk among H-patients.

KCNQ1 gene variants and risk of new‐onset diabetes in tacrolimus‐treated renal‐transplanted patients

Recent genome-wide association studies identified single-nucleotide polymorphisms (SNPs) in the gene encoding the pore-forming subunit of the voltage-gated K+ channel (KCNQ1) as a risk factor for type 2 diabetes. Tacrolimus (Tac) increased the risk of new-onset diabetes after transplantation (NODAT). The aim of this study was to analyze the association between KCNQ1 variants and the risk for NODAT in kidney-transplanted patients who received Tac as primary immunosuppressor. We genotyped three common KCNQ1 SNPs in 145 Spanish patients who received a cadaveric kidney graft and developed NODAT in the first-year post-transplant (the NODAT group), and 260 patients who remained non-diabetics (non-NODAT). In addition, we searched for DNA variants in the whole KCNQ1 coding exons in these patients. SNP rs2237895 (genotype CC) was associated with an increased risk for NODAT in our population (p = 0.008; OR = 1.83, 95% CI = 1.14-2.93), independently of other risk factors as body mass index, recipient age, or tacrolimus dosage. Other KCNQ1 variants were not associated with NODAT in our patients. Our work supported a role for KCNQ1 gene variants as determinants of the risk of developing NODAT among Tac-treated patients.

Pre-transplant weight but not weight gain is associated with new-onset diabetes after transplantation: a multi-centre cohort Spanish study.

Background. New-onset diabetes after transplantation (NODAT) is associated with poorer outcomes in kidney transplantation (KT). Thus, identification of modifiable risk factors may be crucial for ameliorating the impact of this entity on transplant outcomes. We assessed the relationships between the weight, body mass index (BMI) and weight gain with NODAT.Methods. We retrospectively analysed 2168 KT performed in Spain during 1990, 1994, 1998 and 2002, with a functioning graft after the first year. At 1 year after KT, three groups were considered: (i) NODAT group (n = 215); (ii) impaired fasting glucose (IFG) group (n = 389); (iii) control group (n = 1564).Results. The incidence of NODAT was 10.8%, 9.9% and 10.0% at 3, 12 and 24 months post-transplantation, respectively. Older recipient age (P < 0.0001) and greater use of tacrolimus (P < 0.0001) were observed in NODAT group. Obesity was more frequent in NODAT group (P < 0.0001), but patients with NODAT had a lower weight gain during the first year after KT (P = 0.038). On multivariate analysis, independent risk factors associated with the development of NODAT were: recipient age [odds ratio (OR): 1.060, P = 0.0001], tacrolimus (OR: 1.611, P = 0.005), triglycerides (OR: 1.511, P = 0.018), positive hepatitis C virus (HCV) status (OR: 1.969, P = 0.001) and pre-transplant body mass index (BMI) (OR: 1.135, P = 0.0001), but not the weight gain.Conclusions. BMI, but not the weight gain at 1 year after transplant, is an independent risk factor for NODAT. Tailoring clinical strategies may minimize the impact of this complication.