A study on glucose metabolism in a small cohort of children and adolescents with kidney transplant

Abstract

Post-transplant diabetes mellitus (PTDM) and impaired glucose tolerance are now considered among the major adverse events following organ transplantation. The present study was aimed at investigating the regulation of glucose metabolism in pediatric recipients of a kidney transplant (KT), receiving tacrolimus or cyclosporine A-based immunosuppression. Twelve subjects, eight males and four females, aged 12.1+/-3.8 yr, and with a mean time from KT of 45.6 months were enrolled in the study. All patients had a basal evaluation of fasting glucose (GF), fasting insulin (IF), C-peptide and glycated hemoglobin (HbA1c) levels. They then underwent oral glucose tolerance test (OGTT), with measurement of blood glucose and insulin concentration. Two children had impaired GF, associated with supernormal HbA1c levels, one patient showed impaired glucose tolerance, none had PTDM. Peripheral insulin resistance, as measured by quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment estimate of insulin sensitivity (HOMA-IR) index, was enhanced in 3 patients. Subsequently, GF significantly increased with time from transplant (p=0.01), while fasting C-peptide and the area under the curve of insulin correlated with creatinine clearance. In conclusion, our results, although generated in a small sample size, would suggest that long-term follow-up of children receiving a KT should extend to explore the response to oral glucose load and at least the basal measure of insulin response.

New onset diabetes mellitus after heart transplantation in children is a common but potentially modifiable burden

“…Despite emerging long-term data in adult patients, new onset diabetes in transplant recipients is less well described in children in terms of incidence and risk factors in large populations. 1,2 In this issue, Sehgal The identified correlates, as discussed by the authors, closely parallel those risk factors known for type 2 diabetes. In that regard, it is tempting to understand new onset diabetes after transplantation in terms similar to that of type 2 diabetes in children.…”

“…Important among these comorbidities is the development of post‐transplant diabetes mellitus, which can be observed in most solid organ transplant settings and has been strikingly common in adult heart transplant recipients. Despite emerging long‐term data in adult patients, new onset diabetes in transplant recipients is less well described in children in terms of incidence and risk factors in large populations . In this issue, Sehgal and colleagues add to this understanding with an analysis of over 2000 children receiving heart transplants based on data available from 1987 to 2014 from the Organ Procurement and Transplant Network (OPTN) …”

Investigation of impaired carbohydrate metabolism in pediatric liver transplant recipients

“…Hyperinsulinemia and insulin resistance were determined according to insulin levels defined in the current literature (25–29) as following: (i) basal insulin levels ≥15 μU/mL before puberty, ≥30 μU/mL at puberty, or (ii) peak insulin level ≥150 μU/mL and/or ≥75 μU/mL at time 120 min in OGTT, or (iii) total insulin level (sum of the insulin levels at 0, 30, 60, 90, and 120 min) ≥300 μU/mL in OGTT. HOMA‐IR [fasting PG (mmol/L) X fasting insulin (μU/mL)/22.5] as a measure of hyperinsulinemia was calculated as well (30) and cut‐off value for insulin resistance was determined as 1.98 ± 0.57 at prepubertal stage, and 3.02 ± 0.76 at puberty (31).…”