Characterization of Remitting and Relapsing Hyperglycemia in Post-Renal-Transplant Recipients

Abstract

BackgroundHyperglycemia following solid organ transplant is common among patients without pre-existing diabetes mellitus (DM). Post-transplant hyperglycemia can occur once or multiple times, which if continued, causes new-onset diabetes after transplantation (NODAT).ObjectiveTo study if the first and recurrent incidence of hyperglycemia are affected differently by immunosuppressive regimens, demographic and medical-related risk factors, and inpatient hyperglycemic conditions (i.e., an emphasis on the time course of post-transplant complications).MethodsWe conducted a retrospective analysis of 407 patients who underwent kidney transplantation at Mayo Clinic Arizona. Among these, there were 292 patients with no signs of DM prior to transplant. For this category of patients, we evaluated the impact of (1) immunosuppressive drugs (e.g., tacrolimus, sirolimus, and steroid), (2) demographic and medical-related risk factors, and (3) inpatient hyperglycemic conditions on the first and recurrent incidence of hyperglycemia in one year post-transplant. We employed two versions of Cox regression analyses: (1) a time-dependent model to analyze the recurrent cases of hyperglycemia and (2) a time-independent model to analyze the first incidence of hyperglycemia.ResultsAge (P = 0.018), HDL cholesterol (P = 0.010), and the average trough level of tacrolimus (P<0.0001) are significant risk factors associated with the first incidence of hyperglycemia, while age (P<0.0001), non-White race (P = 0.002), BMI (P = 0.002), HDL cholesterol (P = 0.003), uric acid (P = 0.012), and using steroid (P = 0.007) are the significant risk factors for the recurrent cases of hyperglycemia.DiscussionThis study draws attention to the importance of analyzing the risk factors associated with a disease (specially a chronic one) with respect to both its first and recurrent incidence, as well as carefully differentiating these two perspectives: a fact that is currently overlooked in the literature.

Comparison of post-transplantation diabetes mellitus incidence and risk factors between kidney and liver transplantation patients

“…We introduce a dataset of liver transplantation patients to complement a dataset of kidney transplantation patients previously used in published analyses by Boloori et al [22]. Together, these datasets allow, for the first time, a comparison of data across transplant types from the same medical institution with respect to PTDM risk and factors that might affect its incidence.…”

High-Density Lipoprotein Particles and Their Relationship to Posttransplantation Diabetes Mellitus in Renal Transplant Recipients

“…Consequently, HDL cholesterol is included in risk scores, drawn from the Framingham Offspring Study Diabetes Mellitus and the Diabetes Prediction Model risk scores [10,37], and is found to be useful for the prediction of PTDM in RTRs [38]. Baloore et al found that HDL cholesterol was inversely associated with both first and recurrent hyperglycemia after renal transplantation [39]. HDL cholesterol modulates glucose metabolism by various mechanisms, such as countering the deleterious effects of oxidized LDL on insulin production and activation of AMP-activated protein kinase [40,41].…”

Data-Driven Management of Post-Transplant Medications: An APOMDP Approach

“…Studies from the Medical Literature. We note that our work is also related to three streams in the medical literature: (1) incorporating the measurement errors of medical tests in decisionmaking for medication regimens (see, e.g., Bennett et al (2007)), (2) analyzing the diabetogenic effect of immunosuppressive drugs (see, e.g., Chakkera et al (2009) andBoloori et al (2015)), and…”

“…), (3) immunosuppressive drugs (e.g., tacrolimus) and diabetes medications (e.g., insulin) prescribed by physicians, and (4) results of medical tests (FPG, HbA1c, and Architect). Further details about our data set can be found in our earlier study (Boloori et al 2015).…”