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

Munshi, Vidit; Saghafian, Soroush; Cook, Curtiss B.; Werner, K. Tuesday; Chakkera, Harini A.

doi:10.1371/journal.pone.0226873

Cited by 27 publications

(23 citation statements)

References 31 publications

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“…Although the majority of PTDM data are derived from kidney transplant recipients, PTDM incidence has been reported as being higher in other solid organs. Compared to kidney transplant recipients, whose PTDM incidence ranges between 10% and 20% [3‐5], PTDM occurs in 20% to 30% of heart transplant recipients [6], 20% to 40% of liver transplant recipients [7‐11], and 20% to 40% of lung transplant recipients [12,13] (as reviewed in [14] and shown in Fig. 2).…”

Section: Introductionmentioning

confidence: 99%

“…2). It may seem that PTDM is more common among liver rather than kidney transplant recipients, as one center, which reported virtually the same immunosuppressant use in both types of solid transplant recipients, found that the incidence of PTDM was much higher in individuals receiving a liver rather than those receiving a kidney transplant (30% vs. 19%, respectively [9]). Risk factors for development of PTDM in liver transplant recipients are most often reported to be age [8], higher BMI [8,10,11], and especially hepatitis C virus (HCV) infection [7,8,10,11] as well as use of tacrolimus [7,8,15,16].…”

Section: Introductionmentioning

confidence: 99%

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Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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Summary Post‐transplant diabetes mellitus (PTDM) shows a relationship with risk factors including obesity and tacrolimus‐based immunosuppression, which decreases pancreatic insulin secretion. Several of the sodium–glucose‐linked transporter 2 inhibitors (SGLT2is) and glucagon‐like peptide 1 receptor agonists (GLP1‐RAs) dramatically improve outcomes of individuals with type 2 diabetes with and without chronic kidney disease, which is, as heart failure and atherosclerotic cardiovascular disease, differentially affected by both drug classes (presumably). Here, we discuss SGLT2is and GLP1‐RAs in context with other PTDM management strategies, including modification of immunosuppression, active lifestyle intervention, and early postoperative insulin administration. We also review recent studies with SGLT2is in PTDM, reporting their safety and antihyperglycemic efficacy, which is moderate to low, depending on kidney function. Finally, we reference retrospective case reports with GLP1‐RAs that have not brought forth major concerns, likely indicating that GLP1‐RAs are ideal for PTDM patients suffering from obesity. Although our article encompasses PTDM after solid organ transplantation in general, data from kidney transplant recipients constitute the largest proportion. The PTDM research community still requires data that treating and preventing PTDM will improve clinical conditions beyond hyperglycemia. We therefore suggest that it is time to collaborate, in testing novel antidiabetics among patients of all transplant disciplines.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

et al. 2020

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“…We utilized 3 previously published datasets on kidney, liver, and heart transplantation patients [ 10 – 12 , 24 , 25 ]. The datasets were compiled through a de-identified chart review with IRB approval.…”

Section: Methodsmentioning

confidence: 99%

“…The kidney and liver patients were followed up at 1-, 4-, and 12-months after transplant and data were collected on the same variables as for the heart patients as well as hypoglycemic medication administered to patients at each time point after transplant. Immunosuppression protocols differed by organ and are described in previous studies on these patient populations [ 10 , 11 ].…”

Section: Methodsmentioning

confidence: 99%

“…There is currently no standardized protocol for regular NODAT screening in the post-transplantation period, and the potential impact of this recommendation is unknown. In previous studies utilizing HbA1c and fasting blood glucose (FBG) as determinants for NODAT diagnosis, collection is inconsistent and unavailable for analysis in many patients across multiple follow-up time points [ 10 – 12 ]. As a result, it is likely that the NODAT incidence is largely underestimated, and that the time course of NODAT development may be different from what is understood in the current literature [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Use of Imputation and Decision Modeling to Improve Diagnosis and Management of Patients at Risk for New-Onset Diabetes After Transplantation

et al. 2021

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Background New-onset diabetes after transplantation (NODAT) is a complication of solid organ transplantation. We sought to determine the extent to which NODAT goes undiagnosed over the course of 1 year following transplantation, analyze missed or later-diagnosed cases of NODAT due to poor hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) collection, and to estimate the impact that improved NODAT screening metrics may have on long-term outcomes. Material/Methods This was a retrospective study utilizing 3 datasets from a single center on kidney, liver, and heart transplantation patients. Retrospective analysis was supplemented with an imputation procedure to account for missing data and project outcomes under perfect information. In addition, the data were used to inform a simulation model used to estimate life expectancy and cost-effectiveness of a hypothetical intervention. Results Estimates of NODAT incidence increased from 27% to 31% in kidney transplantation patients, from 31% to 40% in liver transplantation patients, and from 45% to 67% in heart transplantation patients, when HbA1c and FBG were assumed to be collected perfectly at all points. Perfect screening for kidney transplantation patients was cost-saving, while perfect screening for liver and heart transplantation patients was cost-effective at a willingness-to-pay threshold of $100 000 per life-year. Conclusions Improved collection of HbA1c and FBG is a cost-effective method for detecting many additional cases of NODAT within the first year alone. Additional research into both improved glucometric monitoring as well as effective strategies for mitigating NODAT risk will become increasingly important to improve health in this population.

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How Should Secondary Causes of Diabetes Be Excluded?

Griffin

O’Loughlin

Dinneen

2021

Clinical Dilemmas in Diabetes

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

Cited by 27 publications

References 31 publications

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Management of post‐transplant diabetes: immunosuppression, early prevention, and novel antidiabetics

Use of Imputation and Decision Modeling to Improve Diagnosis and Management of Patients at Risk for New-Onset Diabetes After Transplantation

How Should Secondary Causes of Diabetes Be Excluded?

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