Diabetes Mellitus After Pediatric Kidney Transplant

Almardini, Reham; Salaita, Ghazi; Albderat, Jawaher; Alrabadi, Katiba; Alhadidi, Aghadir Mohammad; Alfarah, Mahdi Qasem; Ruqa’a, Ala’ Abu; Dahabreh, Dina

doi:10.6002/ect.2017.0328

“…In this study, the majority of KT recipients were male, and the most common etiology of ESRD was congenital anomalies of the kidneys and urinary tract, both of which are consistent with previously published reports 3–10 . However, there were no patients with ESRD caused by obstructive uropathy, which is more common in boys.…”

Section: Discussionsupporting

confidence: 91%

“…[3][4][5][6][7][8][9][10] However, there were no patients with ESRD caused by obstructive uropathy, which is more common in boys. Peritoneal dialysis was the preferred renal replacement therapy while waiting for a KT because of its advantages in children and the Thai national health security policy.…”

mentioning

confidence: 99%

Outcomes of pediatric deceased donor kidney transplant in northeast Thailand

Ratviset,

Panombualert,

Chathum

et al. 2023

Pediatric Transplantation

0

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BackgroundKidney transplantation (KT) is the best therapy in children with end‐stage renal disease (ESRD), however, improving long‐term graft survival remains challenging. The aim of this study was to determine graft survival and potential risk factors in pediatric patients who undergo deceased donor KT with a steroid‐based regimen.MethodsThe medical records of children who underwent their first deceased donor KT in Srinagarind Hospital (Khon Kaen, Thailand) between 2001 and 2020 were reviewed.ResultsSeventy‐two patients were studied. Male adolescents were the predominant recipients and the majority of donors were young adult males. Non‐glomerular disease, particularly hypoplastic/dysplastic kidney disease, was the major cause of ESRD (48.61%). The mean cold ischemic time (CIT) was 18.29 ± 5.29 h. Most of the recipients had more than 4 human leukocyte antigen (HLA) mismatched loci with positive HLA‐DR mismatch (52.78%). Induction therapy was administered in 76.74% of recipients. Tacrolimus plus mycophenolate sodium and prednisolone was the most common immunosuppressive maintenance regimen (69.44%). Graft failure occurred in 18 patients, mostly due to graft rejection (50%). Graft survival at 1, 3, and 5 years after KT were 94.40%, 86.25%, and 74.92%, respectively. The only significant risk factor of graft failure in this study was delayed graft function (DGF) (adjusted HR = 3.55; 95%CI: 1.14, 11.12; p = .029). Patient survival at 1, 3, and 5 years was 100%, 98.48%, and 96.19%, respectively.ConclusionThe short‐term outcomes of pediatric KT from deceased donors were satisfactory; however, prevention of DGF would result in better outcomes.

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“…Its etiopathogenesis is multifactorial, and transplant-related risk factors for PTDM include immunosuppressants, ethnicity, age, sex, body mass index, genetic factors, hepatitis C and cytomegalovirus infections, and family history of diabetes [ 2 ]. Immunosuppressive drugs consisting of corticosteroids and calcineurin inhibitors are important risk factors of PTDM, contributing to the development of hyperglycemia and diabetes [ 4 ]. Tacrolimus (TAC) and cyclosporin (CsA) are two major calcineurin inhibitors required after transplantation to prevent acute or chronic graft rejections [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Tacrolimus (TAC) and cyclosporin (CsA) are two major calcineurin inhibitors required after transplantation to prevent acute or chronic graft rejections [ 1 ]. The mechanisms underlying the diabetogenic effect of immunosuppressive regimen include enhancing insulin resistance, reducing insulin secretion, and direct toxic effects on pancreatic β -cells [ 4 ]. It has also been suggested that glucocorticoid-induced hyperglycemia is partially reversible through avoidance or early withdrawal of the drugs [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Association between Genetic Polymorphisms and Risk of Kidney Posttransplant Diabetes Mellitus: A Systematic Review and Meta-Analysis

Xu

¹

,

Jiang

²

,

Hu

³

2022

International Journal of Clinical Practice

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Objectives. The purpose of this study was to clarify the role of genetic factors on posttransplant diabetes mellitus (PTDM) risk. Methods. Relevant publications were systematically retrieved from PubMed, EMBASE, and the Cochrane Library up to December 2020. Data from eligible case-control and cohort studies were extracted for qualitative and quantitative analyses. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate the association between gene polymorphisms and PTDM in the quantitative meta-analysis. Results. A total of 43 eligible articles were identified, and 16 studies on 9 DNA variants from 8 genes were included in the meta-analysis. TCF7L2 rs7903146 was significantly associated with PTDM risk in 5 genetic models (OR (95% CI): allelic: 1.59 (1.17–2.16), P = 0.003 ; dominant recessive: 1.62 (1.14, 2.31), P = 0.007 ; recessive: 1.87 (1.18, 2.94), P = 0.007 ; homozygote: 2.21 (1.23, 3.94), P = 0.008 ; and heterozygote 1.50 (1.08, 2.10), P = 0.017 ). KCNQ1 rs2237892 was significantly correlated with PTDM risk in 3 genetic models (allelic: 0.68 (0.58, 0.81), P < 0.001 ; dominant: 0.6 (049, 0.74), P < 0.001 ; and heterozygote: 0.61 (0.48, 0.76), P < 0.001 ). KCNJ11 rs5219 was significantly linked with PTDM in the recessive genetic model (1.59 (1.01, 2.50), P = 0.047 ). No significant correlations of PTDM with TCF7L2 rs12255372, SLC30A8 rs13266634, PPARγ rs1801282, CDKN2A/B rs10811661, HHEX rs1111875, and IGF2BP2 rs4402960 polymorphisms were found. Conclusions. The gene polymorphisms of TCF7L2 rs7903146, KCNQ1 rs2237892, and KCNJ11 rs5219 may predispose kidney transplant recipients to PTDM. Large sample size studies on diverse ethnic populations were warranted to confirm our findings.

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“…However, KT is not a complication-free modality of kidney replacement therapy (KRT). One of the important complications after KT is the development of new-onset diabetes mellitus after transplant (NODAT), which affects patient and kidney survival, and is associated with increased risk of cardiovascular (CV) morbidity [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Monitoring of blood glucose after pediatric kidney transplantation: a longitudinal cohort study

Salah

¹

,

Hafez

²

,

Selem³

et al. 2022

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Background Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children. Methods Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year. Results Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0–24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC = − 0.57). Conclusions Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

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Diabetes Mellitus After Pediatric Kidney Transplant

Cited by 6 publications

References 22 publications

Outcomes of pediatric deceased donor kidney transplant in northeast Thailand

Outcomes of pediatric deceased donor kidney transplant in northeast Thailand

Association between Genetic Polymorphisms and Risk of Kidney Posttransplant Diabetes Mellitus: A Systematic Review and Meta-Analysis

Monitoring of blood glucose after pediatric kidney transplantation: a longitudinal cohort study

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