New-onset Diabetes After Transplantation In Patients Research Articles

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<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

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.

A new scoring system to predict the incidence of new onset diabetes after transplantation (NODAT)

Background. We performed this study to develop a new scoring system to stratify different levels of risk of developing new onset diabetes after transplantation (NODAT) in patients who underwent renal transplantation. Many prognostic variables have been previously described but few efforts have been made to group them in order to enhance their individual predictive power. Material and methods. In a first phase, 100 patients were prospectively analysed to determine which factors were significantly associated with the development of NODAT. A risk score ranging from 0 to 10 points was developed using a multivariate analysis. In a second phase, such score was validated in a new sample of 100 patients. Results. BMI ≥ 23.5 kg/m 2 , age ≥ 38.5 years, fasting blood sugar at 1 st post-operative day ≥ 159.5 mg/dL, fasting blood sugar at 5th post-operative day ≥ 122.5 mg/dL and HOMA-IR ≥ 2.5 were found as independent prognostic variables. A clear distinction was shown among categories of low, intermediate and high risk, defined according to the risk score. Conclusion. This new scoring framework is basic and simple to accomplish. It permits a generally excellent stratification of risk of developing NODAT in patients undergoing renal transplantation. They might be separated in three risk stratification cohorts, which could be of help in early identification of NODAT.

New onset diabetes after kidney transplantation in patients with autosomal dominant polycystic kidney disease: systematic review protocol

IntroductionAutosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder with numerous cysts developing in bilateral kidneys. Meanwhile, ADPKD can also be regarded as a systemic disease...

Pretransplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

Aims. To evaluate the predictive power of pretransplant HbA1c for new-onset diabetes after transplantation (NODAT) in kidney transplant candidates, who had several predispositions for fluctuated HbA1c levels. Methods. We performed a retrospective study of 119 patients without diabetes who received kidney transplantation between March 2000 and January 2012. Univariate and multivariate logistic regression analyses were used to investigate the association of several parameters with NODAT. Predictive discrimination of HbA1c was assessed using a receiver-operating characteristic curve. Results. Seventeen patients (14.3%) developed NODAT within 1 year of transplantation. Univariate logistic regression analysis revealed that recipient age, gender, and HbA1c were predictors of NODAT. In the multivariate analysis, the association between pretransplant HbA1c and NODAT development did not reach statistical significance (P = 0.07). To avoid the strong influence of high-dose erythropoietin on HbA1c levels, we performed subgroup analyses on 85 patients receiving no or low-dose (≤6000 IU/week) erythropoietin. HbA1c was again an independent predictor for NODAT. Receiver-operating characteristic analysis revealed a cut-off value of 5.2% with an optimal sensitivity of 64% and specificity of 78% for predicting NODAT. Conclusions. Our results reveal that the pretransplant HbA1c level is a useful predictor for NODAT in patients receiving no or low-dose erythropoietin.

HbA1c and Postprandial Glucose both Have Excellent Probability for Diagnosis of NODAT at both 12- or 52 Weeks Post Kidney Transplantation Compared to Fasting Glucose Alone

Introduction: Glycated haemoglobin (HbA1c) can be utilised to diagnose diabetes mellitus in the general population, but guidance regarding its utility in the transplant population is limited and lacks validation. Beyond 3-months post-transplantation HbA1c may be useful to diagnose new-onset diabetes after transplantation (NODAT) and easier to perform than an oral glucose tolerance test (OGTT). We analysed the sensitivity of three diagnostic markers for diabetes (fasting glucose, postprandial glucose and HbA1c) for diagnosis of NODAT at 12- or 52-weeks post kidney transplantation. Methods: In this prospective analysis, 72 non-diabetic kidney transplant recipients received an OGTT at weeks 12 and 52 post-transplantation with concomitant HbA1c analysis. All patients received standard immunosuppression of basiliximab induction with maintenance tacrolimus, mycophenolate mofetil and corticosteroids. Patients were classed with NODAT in accordance to American Diabetes Association guidelines; fasting blood glucose ≥ 7.0 mmol/L, postprandial blood glucose ≥ 11.1 mmol/L or HbA1c ≥ 6.5%. Correlation between continuous variables was by Pearson's or Spearman's rank test for parametric and non-parametric data respectively. Receiver operator characteristics (ROC curve analyses) were performed to determine the probability of having NODAT. All statistics were performed using SPSS software, with a p value < 0.05 considered significant. Results: NODAT was diagnosed in 22.9% and 19.6% of recipients at 12- and 52 weeks post-transplant respectively. ROC curve analyses for probability of NODAT at 12-weeks were; 12-week fasting glucose (AUC=0.713, p=NS), 12-week HbA1c (AUC=0.991, p< 0.001) and 12-week postprandial glucose (AUC=0.984, p=0.001). ROC curve analyses for probability of NODAT at 52-weeks were; 52-week fasting glucose (AUC=0.599. p=NS), 52-week HbA1c (AUC=0.935, p=0.001) and 52-week postprandial glucose (AUC=0.796, p=0.023). Incorporating both time points for analysis HbA1c had the greatest probability of predicting NODAT with an AUC 0.921 (p< 0.001), with sensitivity 84.2%, specificity 100.0% and accuracy of 96.8%. This compared favourably to postprandial glucose (AUC=0.773, p< 0.001), whilst fasting glucose had poor probability (AUC=0.591, p=NS). Excluding patients diagnosed with NODAT by HbA1c alone at 12- or 52-weeks, HbA1c still demonstrated excellent sensitivity for probability of NODAT in the remaining patients with an AUC of 0.926 (p< 0.001). 12-week OGTT showed HbA1c correlated strongly with postprandial glucose (r=0.700, P< 0.001), but had only moderate correlation with fasting glucose (r=0.475, p=0.002). 52-week OGTT showed moderate correlation between HbA1c and fasting glucose (r=0.338, p=0.041) with only a trend towards correlation between HbA1c and postprandial glucose (r=0.307, p=0.064). Conclusion: HbA1c is comparable to postprandial glucose for diagnosis of NODAT beyond 3-months post-transplantation, both of which are superior to fasting glucose. Due to ease of use, HbA1c should be formally incorporated into diagnostic classification for NODAT in patients beyond 3-months post-transplantation to facilitate immediate clinical utilisation.

Low serum adiponectin level is predictor of arterial stiffness in new onset diabetes after renal transplantation

Background: The purpose of this study was to determine whether the level of adiponectin in serum of renal transplant patients is associated with arterial stiffness related to new onset diabetes after transplantation (NODAT). Methods: A total of 90 previously non-diabetic patients who underwent renal transplantation between 1999 and 2009 were enrolled. We evaluated their diabetic risk factors, lipid profiles, brachial-ankle pulse wave velocity (baPWV), ankle-brachial blood pressure index (ABPI) and serum adiponectin level before and after transplantation. Results: Eleven (12.2%) patients were diagnosed with NODAT and 79 (87.8%) without (non-NO-DAT). The mean post-transplant serum adiponectin level in NODAT patients was significantly lower than that in non-NODAT patients (11.9 vs. 16.4 μg/ml, p = 0.01), whereas the mean baPWV level in NODAT patients was significantly higher (1686 vs. 1468 cm/s, p = 0.016). We found a significant inverse correlation between mean pre-transplant serum adiponectin and baPWV level (r = -0.27, p = 0.011). Furthermore, patients with lower pretransplant serum adiponectin levels (<20 μg/ml) developed NODAT significantly more frequently than those with higher levels (p = 0.038) and the mean baPWV level in the former was also significantly higher (1520 vs. 1412 cm/s, p = 0.047). Conclusion: Our results indicate that low pre-transplant serum adiponectin level is associated with arterial stiffness in development of NODAT in patients who undergo renal transplantation.

Pretransplant Fasting Glucose Predicts New-Onset Diabetes after Liver Transplantation

New-onset diabetes after transplantation (NODAT) is common after liver transplant and associated with poorer outcomes. The aim of this study was to identify risk factors for NODAT in liver transplant recipients off corticosteroids. In 225 adult nondiabetic liver transplant recipients, the mean age was 51.7 years, the majority were men (71%), and half had HCV (49%). The mean calculated MELD score at transplantation was 18.7, and 19% underwent living-donor transplant (LDLT). One year after transplantation, 17% developed NODAT, and an additional 16% had impaired fasting glucose. The incidence of NODAT in patients with HCV was 26%. In multivariate analysis, HCV, pretransplant FPG, and LDLT were significant. Each 10 mg/dL increase in pretransplant FPG was associated with a twofold increase in future development of NODAT. The incidence of NODAT after liver transplant in patients off corticosteroids is 17%. Risk factors for developing NODAT include HCV and pretransplant FPG; LDLT is protective.