Different Course of the Microvascular Complications of Diabetes Mellitus in Kidney Transplant Recipients with Posttransplant Diabetes—A Longitudinal Study

Abstract

Objective: This study assessed microvascular complications (MC) occurrence in renal posttransplant diabetes mellitus (PTDM). Methods: Patients ≥ 5 years of PTDM were included from a cohort of 895 kidney recipients (KR) transplanted in 2000-2011. Diabetic retinopathy (DR) was evaluated by fundus photographs (FP) and optical coherence tomography (OCT). Diabetes kidney disease was evaluated by protein to creatinine ratio (PCR) and eGFR. Distal polyneuropathy (DPN) was assessed by Michigan Protocol/monofilament foot exam. Ewing protocol identified cardiovascular autonomic neuropathy (CAN). Controls were KR transplanted in the same period but without PTDM (NPTDM). Results: After 578 weeks, 135 (15%) KR developed PTDM, 64 with PTDM ≥ 5 years. None of PTDM KR presented DR at FP but thinning of inner retinal layers was observed with OCT (Figure 1). More than 60% of PTDM KR had DPN (OR 1.55; CI 1.26-1.91; p<0.001). Frequency of CAN was similar between PTDM and NPTDM KR (p=0.26). During the 1st year and after 8.5±3.0 years of transplantation, eGFR and PCR did not differ between groups. Conclusions: This is the first longitudinal study to assess MC in PTDM KR. A lower than expected prevalence as well as a different clinical course of the MC was observed. PTDM seems to be a unique type of DM and its consequences may be milder than expected in type 1 and type 2 DM. Disclosure T.M. Londero Gai: None. L.S. Giaretta: None. R.C. Manfro: None. L.H. Canani: None. D. Lavinsky: None. C.B. Leitao: None. A. Bauer: None.