Objectives:This study aimed to determine the pre-transplant risk factors as independent predictors on the new-onset of diabetes mellitus after renal transplants (NODATs).Materials and Methods:A single-centred prospective real-world observational study of 100 subjects who underwent renal transplantation over a period of 2 years. All known patients with diabetes were excluded from the study. NODAT was defined according to the American Diabetes Association definition. In addition to pre-transplant workup 2 days prior to transplant, post-transplant follow-up done on weekly basis for 1st month, every 15th day from 1st month to 3rd month, monthly from 3rd month to 12th month. Each transplant patient followed up for 1 year post-transplant or for 6 months post-development of NODAT, whichever was later. All the pre-transplant variables namely body mass index (BMI), family history of diabetes mellitus (DM), HbA1c, fasting insulin level, fasting c-peptide level, serology for hepatitis B, C, serum magnesium level and pre-operative insulin ressistance were further compared between NODAT and non-NODAT groups at the end of the study to assess their strength of associations.Results:Among the 100 subjects included in the study, 24 developed NODAT. Risk factors namely age, family history of DM, BMI, hepatitis B and C infection, total cholesterol, triglyceride level, pre-operative HbA1c, pre-operative insulin resistance and pre-diabetes were significantly higher, whereas beta-cell function, ABO compatibility and magnesium levels being significantly lower in NODAT cohort.Conclusion:The incidence of NODAT is quite high (24%). Risk of development of NODAT was related to traditional as well as novel risk factors. Key aspects lies in identifying patients at risk of developing NODAT, using traditional risk factors for early diagnosis and introducing interventions on modifiable risk factors for prevention and timely intervention.
We checked DSA and stained the specimens with H&E, masson's trichrome, PAS, silver staining and used Banff 09 classification. Immunofluorescence and C4d stainings were also done. Results: Among the 10 patients,20% had a history of acute rejection (AR); of these,10% had acute antibody-mediated rejection (a-AMR).Among the 86 BS of TG,the TG was mild in 35 cases (cg1),moderate in 28 cases (cg2) and severe in 23 cases (cg3).Peritubular capillaritis was present in 74 bs (86%), transplant glomerulitis in 65 (76%),interstitial fibrosis and tubular atrophy (if/ta) in 71 (83%),thickening of the peritubular capillary (ptc) basement membrane in 72 (84%), and interstitial inflammation in 40 (47%).C4d deposition in the ptc was present in 49 bs (57%); 39 of these 49 bs showed diffuse c4d deposits in the ptc (c4d3),while the remaining 10 bs showed focal deposits (c4d2).Diffuse c4d deposition in the glomerular capillaries (GC) was seen in 70 bs (81%), while focal c4d deposition in the GC was seen in 9 (11%). In the assay using plastic beads coated with HLA antigen performed in 67 serum samples obtained in the peri-biopsy period, circulating ant-HLA alloantibody was detected in 55 (82%); in 33 of the 55 (49%) samples, donor-specific antibodies (DSA) were detected. Among our study, the findings in 22 bs (26%) fully met the criteria for c-AMR in banff '09 classification, including TG, c4d deposition in the ptc and presence of DSA, while those in 27 BS were suspicious of c-AMR. Deterioration of the renal allograft function after the biopsies was seen in 31 patients (62%). Conclusions: We suggest that histopathological changes of transplant glomerulopathy might be accompanied by inflammation of the microvasculature, such as transplant glomerulitis and peritubular capillaritis, thickening of the peritubular capillary basement membrane, and circulating anti-HLA antibodies. C4d deposition in the ptc is not always present in biopsy specimens of TG. Anti-HLA antibody class II, particularly when the antibody was DSA class II, appeared to be associated with the development of TG. The prognosis of grafts exhibiting TG was poor even under the currently used standard triple immunosuppressive regimen.
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