Fatores de risco para o desenvolvimento de diabetes mellitus pós-transplante renal

Abstract

We evaluated retrospectively 34 patients with post-kidney transplant diabetes (PTDM) (group 1) and 68 submitted to renal transplant without PTDM (group 0) to determine the prevalence and risk factors for developing PTDM in patients followed at the Hospital Universitário Pedro Ernesto. The prevalence of PTDM was 7.4%. Group 1 patients were older at data collection (p<0.005) and at transplantation (p<0.005). Among them there was a higher frequency of cadaver donors (p= 0.023) and hypercholesterolemia (p= 0.006), and a lower frequency of arterial hypertension (p<0.0001). We observed a trend to higher frequency of positive sorology for C hepatitis (p= 0.057) and use of tacrolimus (p= 0.069) in group 1 as compared to group 0. The most important risk factors for developing PTDM (by logistic regression) were the age at renal transplant [OR= 1.099, IC 95% (1.045-1.156), p= 0.0001] and positive sorology for C hepatitis [OR= 3.338, IC 95% (1.205-9.248), p= 0.020]. We conclude that the prevalence of PTDM in our hospital was similar to that found in the literature and that the patients who developed PTDM presented a higher prevalence of traditional risk factors for PTDM, like older age and positive C virus hepatitis sorology, comparing to controls.

Modifiable Variables Are Major Risk Factors for Posttransplant Diabetes Mellitus in a Time-Dependent Manner in Kidney Transplant: An Observational Cohort Study

“…Our study documented a PTDM cumulative incidence within three-year posttransplant of 13.5% in recipients using current immunosuppressive regimen in the modern era, which is in agreement with rates of 7.5-21% in the literature [16,17]. PTDM rates may increase over time, e.g., 27%, 21%, 21%, and 30% within 3, 12, 24, and 36 months after transplant, respectively [16].…”

“…Controversial data are equally documented in relation to donor transplant, which may be attributed to differences in immunosuppressive regimen and demographic variables. Therefore, DD transplant may be a risk PTDM when compared to LD transplant [17], while other studies, including our study, did not find that association [18,27].…”

“…Calcineurin inhibitors are also a risk factor for PTDM, mainly FK-based regimen [17,28,33]. We documented that FK trough level, even at therapeutic target, within 1-, 3-, and 6-month posttransplant was predictors of PTDM, as reported in liver transplant for FK trough levels greater than 5.9 ng/mL in the sixth month [34] and after pancreas transplant, when high trough levels of FK lead to islet cell swelling and vacuolization [35].…”

Fatores de risco cardiovascular em pacientes pediátricos após um ano de transplante renal

“…O controle da pressão arterial para manter a estabilidade funcional do enxerto é essencial, bem como na profilaxia de complicações sistêmicas (5) . A hipertensão arterial sistêmica é uma complicação freqüente do transplante renal, com prevalência de até 80% em algumas séries estudadas e representa um importante fator de risco para doença cardiovascular e menor sobrevida do enxerto renal tanto em adultos quanto em crianças (6)(7)(8)(9) .…”