New-onset Diabetes Mellitus After Transplantation Research Articles

Different Dietary Patterns and New-Onset Diabetes Mellitus After Kidney Transplantation: A Cross-Sectional Study

To verify the association of dietary patterns and dietary components with new-onset diabetes mellitus after transplantation (NODAT). Cross-sectional study. Adult kidney transplant recipients, without history of diabetes before transplantation, who received a kidney transplant and were followed up for at least 1year. One hundred and sixteen subjects recruited between January 2013 and August 2014. Diagnosis of NODAT was established according to the American Diabetes Association criteria for type 2 diabetes. Demographic, clinical, and anthropometric data were collected. Dietary intake was assessed by food frequency questionnaire, administered by a registered dietitian. Dietary patterns were identified by cluster analysis. Chi-square test was used to verify the association between dietary patterns and NODAT. Total energy, fiber, and cholesterol intake were calculated. Consumption of macronutrients, carbohydrates, proteins, and fats (total fats and saturated, monounsaturated, polyunsaturated and trans fatty acids), were expressed in percentage of total energy intake. Twenty-eight patients developed NODAT in the follow-up period. They presented higher body mass index and body fat percentage, as well as higher levels of triglycerides and urinary protein/creatinine ratio than the non-NODAT group. Two dietary patterns, I and II, were identified. Pattern II was characterized by higher intake of total, saturated, monounsaturated, and trans fats than pattern I. No association between the dietary patterns and NODAT was identified (P=.905), and there was no difference in the distribution of macronutrients, dietary fiber, and dietary cholesterol between the groups with and without NODAT. Posttransplant dietary patterns were not different between patients with and without NODAT. Further larger and prospective studies are needed to evaluate a possible relationship between dietary components and NODAT incidence in kidney transplant recipients.

NEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION: SINGLE CENTER EXPERIENCE

New-onset diabetes mellitus after transplantation (NODAT) in kidney transplant recipients promote the development of complications and have a negative impact on kidney transplantation (KT) results. Aim. Comparison of clinico-demographic characteristics and KT results in recipients with and without NODAT. Patients and methods. Study included 439 patients 18+ years without pre-transplantation diabetes who underwent KT from the deceased donor in our center from 01.01.2007 to 31.12.2016. All patients after KT received calcineurin inhibitors and mycophenolate, 322 received tacrolimus (TAK), 117cyclosporin A (CsA). Seventeen recipients received immunosuppression without steroids. Results. NODAT developed in 41 (9.3%) of 439 patients: 33 (10.2%) of 322 on TAK, and 8 of 117 (6.8%) on CsA, p=0.368. The groups with NODAT and without NODAT did not differ in gender, proportion of patients with polycystic kidney disease, modality and duration of dialysis, features of immunosuppression, although there was a tendency for older age and higher body mass index in patients with NODAT. In NODAT group there were significantly more patients with preexisting metabolic syndrome (31.7% versus 12.3%, p = 0.002), post-transplant surgical complications (21.9% vs. 8.5%, p= 0.012), fungal infections (14.6% vs 5.0%, p=0.026), cardiovascular complications (26.8% vs. 9.8%, p=0.003), patients who died with functioning graft (17.1% % vs. 5.5%, p = 0.0012). Recipients and transplants survival was significantly lower in NODAT group (p=0.008, p=0.022, resp.). Conclusion. NODAT negatively affects the results of KT. Prevention, early detection and adequate treatment of NODAT can reduce the incidence of complications after KT and improve recipients and transplants survival.

Immunosuppression with prolonged-release tacrolimus in kidney or liver transplantation in India

Aim: Tacrolimus has proven efficacy as an immunosuppressive therapy to prevent transplant rejection and is widely used as an immediate-release formulation in a twice-daily regimen. Once-daily prolonged-release tacrolimus aims to improve the outcomes by reducing variability in exposure and improving adherence. However, there are limited published data available on prolonged-release tacrolimus in routine clinical practice in India. Methods: This was a Phase IV, multicenter, prospective study of prolonged-release tacrolimus conducted over 12 weeks in adult patients eligible for de novo kidney or liver transplantation in India. Primary efficacy end-point was the event rate of biopsy-confirmed acute rejections (BCARs). Secondary end-points included corticosteroid-resistant rejection incidence, time to first BCAR, graft loss, and death. Safety end-points included renal function, lipid profile, incidence of new-onset diabetes mellitus after transplantation (NODAT), and infection. Results: The study enrolled 92 patients undergoing kidney (81 [88.0%]) or liver transplantation (11 [12.0%]); a total of 76 patients (82.6%) completed the study. Ten kidney transplant patients (overall 10.9%) experienced BCAR. There were seven corticosteroid-sensitive and three corticosteroid-resistant rejections. Median (range) time to kidney transplant rejection was 6.5 (1.0–76.0) days. Renal function was stable or improved. Lipid levels showed a significant increase. Eleven instances of NODAT and seven infections occurred and there were eight deaths (8.7%; six kidney and two liver transplant patients). Conclusions: In de novo kidney and liver transplant recipients in India, prolonged-release tacrolimus was well-tolerated and efficacious with a low incidence of acute rejection. Safety profile was similar to immediate-release tacrolimus from published data.

Pretransplantation Risk Factors Associated With New-onset Diabetes After Living-donor Kidney Transplantation

Mid-term date of kidney recipients with new-onset diabetes mellitus after transplantation (NODAT) was poor. We made a retrospective study of 397 patients who had living-donor kidney transplantation between January 2007 and May 2010 in our center. Pretransplantation risk factors for NODAT were identified by univariate and multivariate analyses. The mean follow-up was 53.5 ± 10.4 months. The prevalence of NODAT was 9.3%. Univariate analyses found the mean recipient age ≥40 years, body mass index (BMI) ≥24 kg/m2, family history of diabetes, fasting blood glucose (FBG) ≥5.6 mmol/L, 2-hour plasma glucose ≥7.8 mmol/L, and tacrolimus were risk factors for NODAT. In logistic regression, BMI ≥24 kg/m2 (odds ratio [OR]: 4.14, confidence interval [CI]: 2.02 ∼ 8.49, P < .001), family history of diabetes (OR: 2.62, CI: 1.09 ∼ 6.34, P = .032), and FBG ≥5.6 mmol/L (OR: 3.21, CI: 1.52 ∼ 6.79, P = .002) were independent risk factors. In conclusion, the mid-term prevalence of NODAT in Chinese renal recipients was low (9.3%). Pretransplantation independent risk factors were BMI ≥24 kg/m2, family history of diabetes, and FBG ≥5.6 mmol/L; thus identifying which factors might help to prevent NODAT.

Effect of Smoking on Development of New Onset Diabetes Mellitus after Transplantation (NODAT) of Kidney

Abstract Purpose: Cigarette smoking has adverse effects on kidney transplant recipients, causing cardiovascular disease, kidney function impairment, and cancer. New onset diabetes mellitus after transplantation (NODAT) represents serious complication of transplantation of solid organs. Methods: In the group of 252 patients after kidney transplantation, we identified smokers and current non-smokers (the patient who has not been smoking or who is ex smoker) for the period of minimum 24 months. In the monitored period of 12 months after transplantation, we detected presence of NODAT in both groups. The group contained only those patients who did not have diabetes mellitus (of type 1 and 2) at the time of kidney transplantation. Results: The group of smokers was composed of 88 patients (34.9 %) and non-smokers 164 patients (65.1 %). The average age of smokers was 52 years ± 12.4, and of current non-smokers it was 44.8 years ± 12.8 (P &lt; 0.0001). The smokers had significantly lower body mass index (BMI) at the time of kidney transplantation (P = 0.0059) and also 12 months after transplantation (P = 0.0069), lower weight gain 12 months after transplantation (P = 0.0220) and larger waist circumference 12 months after transplantation (P &lt; 0.0001). Conclusion: In our group, smoking had no effect on development of NODAT, the smokers had lower values of BMI and waist circumference, however, the guideline development group feels that, as for the general population, success of smoking cessation can be enhanced by offering structured smoking cessation programs.

New-onset diabetes mellitus after living-donor liver transplantation: association with graft synthetic function.

It is now known that post-transplant graft function after deceased-donor liver transplantation and living-donor liver transplantation (LDLT) differ; however, there is no report assessing the relationship between graft function and the development of new-onset diabetes mellitus after transplantation (NODAT). We conducted this study to identify the predictive risk factors for NODAT, including graft function after LDLT. The subjects of this study were 175 adult recipients who underwent LDLT at Kyoto University Hospital between 2006 and 2010, and survived for more than 3months (median observation period, 1046days). The 1-, 2-, and 3-year incidences of NODAT after LDLT were 26.1, 32.0, and 33.4%, respectively. Pre-transplant diabetes was associated with poor survival (p=0.0048), whereas NODAT was not associated with patient survival. In the multivariate analysis, recipient age ≥40, a tacrolimus trough level ≥8ng/mL 3months after LDLT, and cholinesterase (ChE) <185IU/L 3months after LDLT were the independent risk factors for NODAT. Poor graft synthetic function 3months after LDLT as well as older age of the recipient and a higher tacrolimus concentration were strongly associated with NODAT development after LDLT.

Co-existing post-transplant membranous nephropathy and diabetic nephropathy: A case report

Membranous nephropathy (MN) is a glomerular disease commonly found in transplanted kidneys. The natural history of MN post-transplant is unpredictable and spontaneous remission is uncommon. Diabetic nephropathy (DN) is also commonly seen in patients with prolonged new onset diabetes mellitus after transplant (NODAT). However, there have been no previous reports of co-existing MN and DN in transplanted kidneys. We herein report a case of a 53-year-old male with early post-transplant proteinuria and microscopic hematuria due to MN with subsequent clinical spontaneous remission. Due to the early onset of disease after transplant and presence of serum anti-phospholipase A2 receptor (anti-PLA2R) antibody, the evidence suggests primary recurrent MN in this patient. He was then diagnosed with NODAT, with fair glycemic control with oral hypoglycemic agents. Sixteen years after remission, he developed recurrent proteinuria and progressive impairment of renal function. The allograft biopsy revealed both MN and DN. Both diseases may have contributed to the development of glomerular pathology in this patient.

Risk factors for new-onset diabetes mellitus after living donor kidney transplantation in Korea - a retrospective single center study.

BackgroundNew-onset diabetes mellitus after transplantation (NODAT) is a serious complication following renal transplantation. The aim of this study was to identify the risk factors for the development of NODAT in Korean transplant patients.MethodsRecipients who underwent living donor kidney transplantation between January 2009 and April 2012 at Asan Medical Center were reviewed. Diagnosis of NODAT was defined according to the American Diabetes Association criteria.ResultsA total of 418 patients were enrolled. NODAT was diagnosed in 85 (20.4 %) patients within 1 year. By multivariate analysis, old age (odds ratio [OR], 1.05; 95 % Confidence interval [CI]: 1.01–1.08), family history of diabetes mellitus (OR, 2.48; 95 % CI: 1.04–5.94), pre-transplant high serum glucose level (OR, 1.04; 95 % CI: 1.01–1.08), and obesity (OR, 3.46; 95 % CI: 1.55–7.73) were independent risk factors for NODAT.ConclusionOld age, family history of diabetes, pre-transplant high plasma glucose level, and obesity are independent factors associated with the development of diabetes after renal transplantation. In contrast, serum magnesium levels and the use of tacrolimus are not associated with the development of NODAT.Electronic supplementary materialThe online version of this article (doi:10.1186/s12882-016-0321-8) contains supplementary material, which is available to authorized users.

Prospective Analysis of Metabolic Parameters in the Detection of Diabetes and Metabolic Syndrome in Liver Transplant Recipients.

Liver transplant recipients are at increased risk of metabolic complications, including new-onset diabetes mellitus after transplantation (NODAT) and post-transplant metabolic syndrome (PTMS), both of which are associated with decreased patient survival. We prospectively monitored traditional and novel metabolic parameters in nondiabetic liver transplantation (LT) candidates to determine their role in detecting these conditions. Nondiabetic adults undergoing initial LT were prospectively identified. NODAT and PTMS were defined according to WHO and ATP III criteria. Metabolic measures were collected at pre-LT, 4, and 12 months post-LT. Of 49 subjects enrolled, 24.5% were found to be diabetic pre-LT by 2-hr oral glucose tolerance test (OGTT) despite fasting glucose below the diabetic range. Two patients developed NODAT post-LT. A single patient was found to have MS at baseline, while PTMS developed in 26% and 31.3% of patients at 4 and 12 months. Novel metabolic markers did not detect these conditions. Screening OGTT detected pre-LT diabetes in patients with normal fasting glucose. Serial measurement of metabolic parameters allowed earlier detection of PTMS. Novel metabolic parameters did not correspond to post-LT outcomes, but provided a baseline for future study. More frequent and intensive metabolic monitoring appears reasonable, but larger studies are needed to clarify its efficacy.

A Case of New Onset Diabetes Mellitus in the Long-Term After Kidney Transplantation

Diabetes which first appears after transplantation is called New Onset Diabetes Mellitus after Transplantation (NODAT). NODAT is associated with increased morbidity and mortality and decreased allograft survival. Risk factors for NODAT are age older than 40 to 45 years, African and Asian ethnicity, presence of polycystic renal disease, impaired glucose tolerance before transplantation, HLA mismatches between recipients and donors, obesity, sedentary life, presence of metabolic syndrome, infection with viruses such as cytomegalovirus (CMV) and hepatitis C virus (HCV), immunosuppressive therapy including corticosteroids for acute rejection, and calcineurin inhibitors.

Correlation between CMV Infection and NODAT

Purpose: New-onset diabetes mellitus after transplantation (NODAT) is a well-known complication of transplantation. Materials and methods: Retrospectively, we detected CMV replication (PCR) in every month after transplantation of kidney in the first 12 months after transplantation in patients in a homogenous group from the aspect of immunosuppresion. Results: In the group of 167 patients (control group: n = 103, NODAT group: n = 64), the average value of CMV viremia was without any significant difference between the NODAT group and the control group (P = 0.9285). In the 10th month after kidney transplantation, we recorded significantly higher CMV viremia in the NODAT group (p < 0.0001), however, in the multi variant analysis, that difference was not confirmed. Thus, in our group, CMV is of no relevance with the development of NODAT in the monitored period. The survival of patients and graft was 12 months after kidney transplantation without any statistically significant difference between the monitored groups (P = 0.6113 - survival of the patient; P = 0.5381 – survival of the graft). Conclusion: Our analysis shows that in regular monitoring of CMV viremia and applying chemoprophylaxison the risk recipeints, CMV is not the risk factor for NODAT.

Analysis of Incretin Hormones After Orthotopic Liver Transplantation

BackgroundSeveral well-known risk factors play an important role in the development of new-onset diabetes mellitus after orthotopic liver transplantation (OLT). Immunosuppressant drugs and hepatitis C virus (HCV) infection have a direct effect on pancreatic beta cells resulting insulin hyposecretion. Steroids mainly cause peripheral insulin resistance. Although in type 2 diabetes mellitus the incretin-insulin axis is impaired and incretin hormones are advantageous targets of many antidiabetic drugs, the endocrinologic background of new-onset diabetes mellitus after transplantation (NODAT) is still not completely understood. MethodsDuring the first postoperative year the oral glucose tolerance test (OGTT) was performed on 21 patients after OLT. Patients' glycemic metabolic status was determined according to the results of OGTT. The level of incretin hormones, namely glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), were measured with competitive enzyme-linked immunoassay reaction. ResultsSix patients had normal glucose tolerance (NGT), 9 had impaired glucose tolerance (IGT, serum glucose 7.8–11.0 mmol/L), and 6 were diagnosed with NODAT (serum glucose >11.1 mmol/L). Fasting insulin and c-peptide levels were higher if IGT/NODAT was found. Insulin secretion was not further stimulated after OGTT. GIP and GLP-1 levels did not differ significantly, not even after glucose load. HCV infection had not influenced the levels of incretin hormones [GLP-1 (0 min): 1.21 ± 0.27 vs 1.38 ± 0.65; P = ns; GLP-1 (120 min): 1.46 ± 0.61 vs 1.07 ± 0.58; P = ns; GIP (0 min): 2.55 ± 0.95 vs 1.99 ± 0.63; P = ns, GIP (120 min): 2.62 ± 0.6 vs 2.33 ± 0.77; P = ns]. ConclusionThe stimulation of insulin secretion in NODAT is limited. Incretin hormones are present independently from the current glycemic status. The use of dipeptidyl peptidase-4 inhibitors through their positive effect on the incretin-insulin axis can be beneficial in the therapy of NODAT after liver transplantation.

Waist circumference as an independent risk factor for NODAT.

New-onset diabetes mellitus after transplantation (NODAT) is a serious and frequent complication of solid organ transplantations. NODAT leads to 2-3 times higher cardiovascular morbidity and mortality. Visceral obesity is a key factor for diabetes mellitus type 2 and metabolic syndrome development, and is an independent risk factor for cardiovascular diseases. The series consisted of 167 patients after primary kidney transplantation from a dead donor (64 patients had developed NODAT), average age of the series was 46.1±11.6 years. We retrospectively examined waist circumference, body mass index, and weight gain in the 12th month after transplantation. We examined average level of triglycerides, cholesterol, and immunosuppression throughout the 12 monitored months. Patients with NODAT were significantly older (P=0.004) and had greater waist circumference (P<0.0001) and higher average sirolimus level (P=0.0262). We identified the following independent risk factors for NODAT by using multivariate analysis: age at the time of transplantation above 50 years (HR=2.5038, [95% CI: 1.7179 to 3.6492], P<0.0001), waist circumference in men greater than 94 cm (HR=1.9492, [95% CI: 1.1697 to 3.2480], P=0.0104) and in women greater than 80 cm (HR=4.5018, [95% CI: 1.8669 to 10.8553], P=0.009). By using correlation coefficient we have proved that greater waist circumference was related to higher incidence of NODAT (r=0.1935, [95% CI: 0.01156 to 0.3630], P=0.0374). Graft survival (death censored) 12 months after kidney transplantation was 97.1% in the control group and 95.3% in the NODAT group (P=0.5381). Patient survival 12 months after kidney transplantation in the control group was 98.1% and in the NODAT group it was 96.9% (P=0.6113). We identified waist circumference as an independent risk factor for NODAT in our analysis.

New onset diabetes mellitus after kidney transplant: prevalence and risk factors

Background New onset diabetes mellitus after transplant (NODAT) has been described in 4-25% of kidney transplant recipients. It is not only a major factor leading to dysfunction and deterioration of the allograft, but also has a significant impact on cardiovascular risk and patient survival. Several risk factors have been linked to this condition such as age, class of immunosupressive drug, obesity and family history of diabetes. However this has been poorly studied in our population.

Prevalence and predictors of diabetes after lung transplantation: a prospective, longitudinal study.

To determine incidence and prevalence of diabetes mellitus (DM) after lung transplantation (LTx), identify risk factors for persistent DM after LTx, and determine its effect on survival. This was a prospective, longitudinal study comparing DM status before and after LTx using oral glucose tolerance tests (OGTTs). DM prevalence and changes in metabolic control over time were determined. Risk factors for persistent DM and survival differences by DM status were assessed. Between August 2010 and December 2012, 156 patients underwent LTx. DM prevalence after 3, 12, and 24 months was 47%, 44%, and 40%, respectively. A further 20%, 11%, and 7% had impaired glucose tolerance and/or impaired fasting glucose. Incidence of new-onset DM after transplant (NODAT) was 32%, 30%, and 24% after 3, 12, and 24 months. Nonfasting insulin levels and second phase insulin release fell 3 months after transplant (Tx) but returned to baseline by 2 years. The only risk factors for NODAT were 1- and 2-h glucose levels on pre-Tx OGTT (OR 1.73 [95% CI 1.19-2.50], P = 0.004, and 1.84 [1.22-2.77], P = 0.004, respectively). Survival was reduced in patients with DM at study end versus those without (estimated mean 979 days [95% CI 888-1,071] vs. 1,140 days [1,070-1,210], P = 0.023). Most patients had dysglycemia during the first year after LTx, and 32% developed NODAT. Hyperglycemia was caused both by β-cell dysfunction and by insulin resistance. Only pre-Tx OGTT glucose levels predicted persistent NODAT. As DM was common and associated with reduced survival, early detection and management of DM in LTx recipients are warranted.

The impact of cytomegalovirus infection on new-onset diabetes mellitus after kidney transplantation: a review on current findings.

Context: New onset diabetes mellitus after transplantation (NODAT) increases the risk of cardiovascular disease, rate of infections, graft rejection and graft loss as well as decreases patient and graft survival rates. There is a controversy surrounding the impact of cytomegalovirus (CMV) infection in the development of NODAT. This meta-analysis aims to identify the role of CMV infection leading to the development of NODAT in kidney recipient patients. Evidence Acquisitions: We searched several electronic databases, including PubMed, Embase, Medline, Scopus, Trip Database and Google Scholar for studies that completely fulfill our criteria between January 1990 and January 2014 Results: Seven studies with 1389 kidney transplant patients were included in this metaanalysis.The mean age of patients ranged from 42.8 to 48.8 years and males made up 53% to 75% of patients in the cohort studies. The incidence of NODAT varies from 14.3% to 27.1% in these studies. Overall adj OR was 1.94 [exp (0.66)] with a 95% CI of 1.26-2.98 [exp (0.23) and (1.09)]. There was no significant publication bias based on the Begg’s and Egger’s test (p value = 0.17 and 0.54, respectively). Conclusions: Our study showed that CMV infection is a risk factor for increasing incidence of NODAT. Thus, prophylaxis against CMV infection after kidney transplantation is strongly suggested. However, further clinical trials and cohorts are needed to confirm this association.

Diabetes mellitus in the transplanted kidney.

Diabetes mellitus (DM) is the most common cause of chronic kidney disease and end stage renal disease. New onset diabetes mellitus after transplant (NODAT) has been described in approximately 30% of non-diabetic kidney-transplant recipients many years post transplantation. DM in patients with kidney transplantation constitutes a major comorbidity, and has significant impact on the patients and allografts’ outcome. In addition to the major comorbidity and mortality that result from cardiovascular and other DM complications, long standing DM after kidney-transplant has significant pathological injury to the allograft, which results in lowering the allografts and the patients’ survivals. In spite of the cumulative body of data on diabetic nephropathy (DN) in the native kidney, there has been very limited data on the DN in the transplanted kidney. In this review, we will shed the light on the risk factors that lead to the development of NODAT. We will also describe the impact of DM on the transplanted kidney, and the outcome of kidney-transplant recipients with NODAT. Additionally, we will present the most acceptable data on management of NODAT.

Low Incidence of New Onset Diabetes Mellitus After Renal Transplantation Under Low-Dose Tacrolimus-Based Immunosuppression: A Single Center Experience.

Introduction:New onset diabetes mellitus after transplantation (NODAT) is a common metabolic complication after renal transplantation, and its incidence varies depending on definition of diagnosis of NODAT, patient group (ethnicity), and immunosuppressive regimen. NODAT could be a cause of poor graft outcomes including infectious complications and poor graft function. We have employed low-dose tacrolimus immunosuppression with low-levels of tacrolimus trough after transplantation. We assessed the incidence of NODAT under low-dose tacrolimus immunosuppression and examined the association between NODAT and graft function after renal transplantation. Patients and Methods:Eight hundred seventy-four renal transplants were carried out at our institution between 1998 and 2013, and all of them were treated with tacrolimus-based immunosuppression. Out of 874, 115 were excluded from this study because they had diabetes mellitus preoperatively -- so called diabetic nephropathy patients. Eight hundred seventy-four patients were enrolled in this retrospective study. All patients had their FBS and HbA1c examined after renal transplantation every 3-6 months. Induction phase, tacrolimus trough levels were 6-10ng/ml and 3-5ng/ml in the maintenance phase. We started treatment by modification of lifestyle and/or antidiabetic medication once NODAT was diagnosed after transplantation. We analyzed the clinical characteristics of recipients, and long-term patient and graft survival. Results:The overall incidence of NODAT was 4.5% (n = 34). Sixteen patients were treated with insulin injection (2%) and 9 patients were on medical treatment. Nine patients were on diet therapy alone. The 10-year patient survival of NODAT and non-NODAT recipients was 79.8% and 97.9%, respectively, and was not significant between two groups. The 10-year graft survival of NODAT and non-NODAT recipients was 73.7% and 89.4%, respectively, and was significant between two groups (p=0.04). Both the tacrolimus dose and trough levels were not different between the two groups at most time points after kidney transplantation. Conclusions:The incidence of NODAT was 4.5% and was low under low-dose tacrolimus immunosuppression. NODAT did not negatively affect patient survival under low-dose tacrolimus immunosuppression, although the graft survival was slightly poorer in NODAT patients than non-NODAT patients.

What Is the Long-Term Effect of CMV Infection After Renal Transplantation?

Cytomegalovirus infection is a major cause of morbidity and mortality during the first post-transplant year. However with the current anti-viral prophylaxis the long-term effects of CMV are less likely to be significant. In this study we have retrospectively analysed the impact of a proven CMV viral infection on long-term graft outcomes.A total of 70 renal transplant recipients with CMV infection were identified between 1988 - 2008. To match these patients 136 age, GFR and graft vintage matched controls (CON) were selected from our centre and the two groups were compared for graft survival, patient survival, new onset diabetes mellitus after transplantation (NODAT) and renal function as assessed by serial serum creatinine values and proteinuria. The median time to CMV infection was 3 months (IQR 0-7) with 94% of these occurring within the first post-transplant year. At 10 year follow-up there was no statistically significant difference in the patient survival and NODAT. However, patients with CMV had significantly worse death censored graft survival (P=0.01). Interestingly this difference in graft survival was only significant in patients with superior baseline renal function when compared to those with relatively poor baseline function.Figure: No Caption available.Patients with CMV had significantly worse proteinuria (measured by urine Protein Creatinine Ratio) over a five year follow-up period when compared to the controls (1yr CMV 42, CON 25, P=0.26; 2yrs CMV 56.8, CON 21.4, P=0.07; 3yrs CMV 46.1, CON 29.9, P=0.2; 4yrs CMV 61.8, CON 31, P=0.04; 5yrs CMV 80.5, CON 28.4, 0.02) Serum creatinine was relatively higher in the CMV group (6 months CMV 176, CON 147, p=0.02; 1yr CMV 159, CON 156, P=Ns; 2yr CMV 171 CON 151, P=0.2; 3yr CMV 180, CON 146, P=0.02; 4yr CMV 183, CON 146, P=0.06; 5yr 160, CON 148, P=Ns). We have finally analysed the immediate effect of CMV on haemoglobin. By 1 year from the time of CMV infection, the haemoglobin levels were similar to those without CMV infection.From this retrospective analysis we conclude that the main long-term impact of CMV infection is on allograft function. This was noticed to be more significant in patients with relatively superior baseline renal function.

Hyperparathyroidism and New Onset Diabetes After Renal Transplantation

BackgroundSecondary hyperparathyroidism persists after renal transplantation in a substantial number of patients. Primary hyperparathyroidism and secondary hyperparathyroidism are both associated with abnormalities in glucose metabolism, such as insufficient insulin release and glucose intolerance. The association of hyperparathyroidism and diabetes after renal transplantation has, as far as we know, not been studied. Our aim was to investigate whether hyperparathyroidism is associated with new-onset diabetes mellitus after transplantation (NODAT) during the first year posttransplantation. Study DesignIn a retrospective study, we analyzed data on patient characteristics, treatment details, and parathyroid hormone (PTH) in 245 adult nondiabetic patients who underwent renal transplantation between January 2000 and June 2011. ResultsThe first year cumulative incidence of NODAT was 15%. The first serum PTH value after transplantation was above normal range in 74% of the patients. In multiple logistic regression analysis, PTH levels above twice normal range (>13.80 pmol/L) were significantly associated with NODAT (odds ratio [OR], 4.25; 95% confidence interval [CI], 1.13–15.92; P = .03) compared with PTH within normal range (≤6.9 pmol/L). Age between 45 and 65 years (OR, 2.80; 95% CI, 1.07–7.36; P = .04) compared with age <45 years was also associated with NODAT. ConclusionWe found a strong association between hyperparathyroidism and NODAT in the first year after renal transplantation. Both conditions are common and have a negative impact on graft and patient survivals. Our results should be confirmed in prospective studies.