Association of Metabolic Syndrome With Development of New-Onset Diabetes After Transplantation

Abstract

Background New-onset diabetes after transplantation (NODAT) is a major post-transplant complication associated with lower allograft and recipient survival. Our objective was to determine if metabolic syndrome pre-transplant is independently associated with NODAT development. Methods We recruited 640 consecutive incident non-diabetic renal transplant recipients from 3 academic centers between 1999 and 2004. NODAT was defined as use of hypoglycemic medication, a random plasma glucose >200 mg/dL, or 2 fasting glucose levels ≥126 mg/dL beyond 30 days post-transplant. Results Metabolic syndrome was common pre-transplant (57.2 %). NODAT developed in 31.4% of recipients one year post-transplant. Participants with metabolic syndrome were more likely to develop NODAT compared to recipients without metabolic syndrome (34.4% v. 27.4%, p=0.057). Recipients with increasing number of positive metabolic syndrome components were more likely to develop NODAT (metabolic syndrome score-prevalence at 1 year: 0-0.0%, 1-24.2, 2-29.3%, 3-31.0%, 4-34.8%, and 5-73.7%, p=0.001). After adjustment for demographics, age by decade (HR-1.34 (1.20-1.50), p<0.0001), African American race (HR-1.35 (1.01-1.82), p=0.043), cumulative prednisone dosage (HR-1.18 (1.07-1.30), p=0.001), and metabolic syndrome (HR-1.34 (1.00-1.79), p=0.047) were independent predictors of development of NODAT at 1 year post-transplant. In a multivariable analysis incorporating the individual metabolic syndrome components themselves as covariates, the only pre-transplant metabolic syndrome component to remain an independent predictor of NODAT was low HDL (HR-1.37 (1.01-1.85), p=0.042). Conclusions Metabolic syndrome is an independent predictor for NODAT and is a possible target for intervention to prevent NODAT. Future studies to evaluate if modification of metabolic syndrome factors pre-transplant reduces NODAT development are needed.

Metabolic Syndrome in Kidney Transplantation

“…Confirming results of the smaller study by Porrini et al (15), this study reported that 31.4% of patients developed new-onset diabetes after transplantation and that pretransplantation metabolic syndrome was a risk factor for posttransplantation diabetes, independent of recipient age, ethnicity, and cumulative steroid dosage (16). Interestingly, using NCEP criteria, the only individual component of the metabolic syndrome that independently predicted new-onset diabetes was a low concentration of HDLs (16).…”

“…More recently, in a multicenter US study designed to assess the value of pretransplantation metabolic syndrome as a predictor of new-onset diabetes after transplantation, Bayer et al (16) recruited 640 consecutive renal transplant recipients without diabetes and reported that 57.2% had metabolic syndrome before transplantation. Confirming results of the smaller study by Porrini et al (15), this study reported that 31.4% of patients developed new-onset diabetes after transplantation and that pretransplantation metabolic syndrome was a risk factor for posttransplantation diabetes, independent of recipient age, ethnicity, and cumulative steroid dosage (16).…”

Cardiovascular risk factors following renal transplant

“…Overall, the pattern of metabolic abnormalities caused by steroids is very similar to that seen in patients with metabolic syndrome [102] . Obesity in RTRs is strongly linked to the development of metabolic syndrome, with around 60% of patients meeting the diagnostic criteria [103] at transplantation and 9%63% in the subsequent years [104,105] . It is independently associated with longterm graft function and is a prominent risk for allograft failure [105] and CV events secondary to atherosclerosis [106] .…”

Post-transplantation diabetes mellitus: an overview

“…Многофак-торный анализ, включающий отдельные компоненты метаболического синдрома, показал, что из всех пред-трансплантационных компонентов метаболического синдрома только уровень липопротеинов низкой плот-ности независимо связан с риском развития ПТСД [32].…”