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.
In Spanish KT recipients with graft function after one yr, PTDM is associated with a worse traditional CVR profile and a higher overall mortality. Although short-term cardiovascular mortality remains similar, better control of CVR factors is mandatory to prevent long-term cardiovascular mortality inherent to this population.
The immunocytochemical analysis of HLA-DR and ICAM-1 on renal tubular cells taken by fine-needle aspiration biopsy, allows the diagnosis of acute cellular rejection and acute vascular rejection even when the Corrected Increment is not increased. Moreover, the risk of a core renal biopsy can be avoided when both tests are negative since an acute rejection is a remote possibility.
Background
In living kidney transplantation two different subjects, a healthy donor and a renal transplant recipient end with a single kidney. This is an excellent human model to study factors that influence kidney function in the context of reduced renal mass and the adaptation of two comparable kidneys to different metabolic demands.
Methods
We analyzed the changes in measured glomerular filtration rate (GFR, iohexol) from pre-transplantation to 12 months after transplantation in 30 donor-recipient pairs. Each donor was compared with its recipient. We defined a priori three different groups based on GFR differences at 12 months: (A) donor > recipient, (B) donor < recipient, (C) donor ≈ recipient. Other factors like donor/recipient mismatches in body mass index (BMI), surface area (BSA) and gender were evaluated.
Results
(Group A) GFR higher in donors than recipients at 12 m (78 ± 8 vs 57 ± 8 ml/min): donors were mostly male and recipient female (75% each). Donors had higher baseline weight than their recipients. During follow-up, weight remained stable in donors but increased 7% in recipients. (Group B) GFR lower in donors than recipients at 12 m (65 ± 11 vs 79 ± 11 ml/min): donors were mostly female (60%) and recipients male. At baseline, donors had lower weight than recipients. At 12 months, weight was stable in donors but increased in recipients. (Group c) GFR similar in donors and recipients (66 ± 7 vs 67 ± 7 ml/min): donors were mostly (75%) female and recipients males. At baseline, donors had higher BMI than their recipients. At 12 months BMI was stable in donors but increased 14% in recipients. In multivariable analysis, higher GFR at 12 months was associated with higher baseline weight and GFR in donors and with male gender and higher baseline weight in recipients.
Conclusions
kidneys from living donors are more ‘plastic’ than originally thought of and respond to metabolic demands and weight changes of their ‘new host’. These changes should be taken into account when assessing GFR outcomes in this population.
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