Clinical evolution of post-transplant diabetes mellitus

Porrini, Esteban; Díaz, J.M.; Moreso, Francesc; MAllen, P; Torres, Irene Silva; Ibernón, Meritxell; Bayés-Genís, Beatriz; Benitez-Ruiz, Rocío; Lampreabe, I; Lauzurrica, Ricardo; Osorio, J.M.; Osuna, Antonio; Domínguez-Rollán, Rosa; Ruiz, Juan Carlos; Jiménez-Sosa, Alejandro; González-Rinne, Ana; Marrero-Miranda, Domingo; Macía, Manuel; Garcı́a, Javier Garcı́a; Torres, Armando

doi:10.1093/ndt/gfv368

Cited by 89 publications

(92 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The present investigations now clearly demonstrate the dynamic nature of glucose metabolism after transplantation, questioning in particular the concept of reporting cumulative incidences in long-term follow-up after transplantation. Porrini and colleagues were the first to demonstrate the reversibility of prediabetes and PTDM in follow-up after kidney transplantation [18]. Our results are in line with and extend these findings, illustrating not only the overall evolution between months 3 and 36 but also the highly dynamic nature of glucose metabolism at sequential time points after kidney transplantation.…”

Section: Discussionsupporting

confidence: 90%

“…In kidney transplant recipients, within a similar period of observation, both Porrini et al and our data demonstrate substantial shifts from the prediabetic state towards both manifest diabetes and NGT. In comparison to the general population, the proportion of patients normalizing glucose metabolism (43%) is higher after transplantation [18]. …”

Section: Discussionmentioning

confidence: 99%

“…Prediabetes has been shown to be an independent risk factor for progression to PTDM [16-18], albeit a modifiable one. Our data clearly show that the risk zone of prediabetes prevails for many years after transplantation, thus providing a continuous opportunity for targeted intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to the classic risk factors, other transplant-specific factors such as immunosuppression contribute to the overall risk of developing PTDM [11, 12]. Prediabetes, one of the classic risk factors for progression to overt type 2 diabetes [13-15], has also been shown to increase the risk for PTDM [16-18]. Prediabetes comprises (i) impaired fasting glucose (IFG), (ii) impaired glucose tolerance (IGT) in standardized oral glucose tolerance test (OGTT), and (iii) glycated haemoglobin A1c (HbA1c) levels between 5.7% and 6.4% [19].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Dynamics of Glucose Metabolism After Kidney Transplantation

Guthoff¹,

Wagner²,

Weichbrodt³

et al. 2017

Kidney Blood Press Res

View full text Add to dashboard Cite

Background/Aims: Posttransplantation diabetes mellitus (PTDM) impacts patient and allograft survival after kidney transplantation. Prediabetes, which is an independent risk factor for PTDM, is modifiable also in a post-transplant setting. Understanding the risks and dynamics of impaired glucose metabolism after transplantation is a key component for targeted intervention. Methods: A retrospective chart analysis of all adult non-diabetic renal allograft recipients (n=251, 2007-2014) was performed. Longitudinal follow-up included fasting plasma glucose and HbA1c, as well as data on allograft function and immunosuppression at consecutive time points (months 3-6 to >5 years post transplantation). Results: Throughout follow-up, median prevalence of prediabetes and PTDM was 53.3 [52.4-55.7]% and 15.4 [15.0-16.5]%, respectively. Continuously high fluxes between states of glucose metabolism, with individual patients’ state deteriorating or improving over time, resulted in a high number of incident patients even long after transplantation. The greatest number of patients shifted between normal glucose tolerance and prediabetes, followed by those between prediabetes and PTDM. Conclusion: Prediabetes and PTDM are highly prevalent after kidney transplantation and incidences remain relevant throughout follow-up. Patient fluxes into and out of the prediabetic state show that glucose metabolism is highly dynamic after transplantation. This provides a continuous opportunity for intervention in an aim to reduce diabetes-associated complications.

show abstract

Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Dynamics of Glucose Metabolism After Kidney Transplantation

Guthoff¹,

Wagner²,

Weichbrodt³

et al. 2017

Kidney Blood Press Res

View full text Add to dashboard Cite

show abstract

“…In a recent analysis of serial oGTTs in 672 KTRs over 5 years posttransplant, Porrini and colleagues reported similar outcomes. 26 In their prospective trial, 28% of patients showed oGTT results indicative of prediabetes and 21% of these patients developed late posttransplant diabetes mellitus during follow-up, similar to our result of approximately 16%. They reported a much higher prevalence of NODAT at 60 months after transplant, at 33.6%, versus 7.8% at about 120 months post transplant in our cohort.…”

Section: Discussionsupporting

confidence: 88%

Untitled

Tillmann

Radtke²,

Rump³

et al. 2017

Exp Clin Transplant

View full text Add to dashboard Cite

Objectives: This study investigated the effect of prediabetes in long-term deceased-donor renal transplant recipients regarding graft survival, graft function, and evolution of new-onset diabetes after transplant compared with a control group of graft recipients with normal glucose tolerance test results. Materials and Methods: This was a follow-up trial of 187 deceased-donor renal transplant recipients. Based on oral glucose tolerance test results, the cohort was divided into groups A and B, comprising individuals with normal glucose metabolism (n = 130, 69.9%) and individuals with prediabetes (n = 56, 30.1%). Data are shown as means ± standard errors. Results: Both groups showed similar total transplant survival (116.8 ± 5.4 vs 114.5 ± 7.4 mo; P = .742) and transplant survival measured since oral glucose tolerance test (58.5 ± 1.4 vs 59.5 ± 1.9 mo; P = .990, Mantel-Cox P = .943). Univariate and multivariate Cox regression analyses showed no association of prediabetes with graft loss. Transplant function changes were similar between cohorts (-3 ± 1 vs -5 ± 2 mL/min/1.73 m 2 body surface area, using the Chronic Kidney Disease Epidemiology Collaboration formula; P = .538). At 5-year follow-up, recipients with prediabetes had higher hemoglobin A1c than controls (5.99% ± 0.10% vs 5.67% ± 0.04%; P = .002). Prediabetes was associated with a 4.5-fold increased hazard of new-onset diabetes after transplant (P = .021). Conclusions: Prediabetes was associated with a 4.5-fold higher hazard ratio for new-onset diabetes after transplant but not with reduced graft function or survival.

show abstract

Diabetic kidney disease and transplantation options

2021

View full text Add to dashboard Cite

Diabetes is the leading cause of chronic kidney disease worldwide and associated with significant morbidity and mortality. Despite advances in treatment options for diabetic kidney disease, a substantial proportion of patients still progress to end‐stage renal disease. While not without its own risk and complications, transplantation remains the best modality of renal replacement therapy in terms of patient outcome and cost‐effectiveness when compared to dialysis. This article reviews diabetic kidney disease with a focus on options for transplantation including kidney, pancreas and islet cell transplantation. Copyright © 2021 John Wiley & Sons.

show abstract

Clinical evolution of post-transplant diabetes mellitus

Cited by 89 publications

References 27 publications

Dynamics of Glucose Metabolism After Kidney Transplantation

Dynamics of Glucose Metabolism After Kidney Transplantation

Untitled

Diabetic kidney disease and transplantation options

Contact Info

Product

Resources

About