Dynamics of Glucose Metabolism After Kidney Transplantation

Abstract

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.

Transplantation and diabetes (Transdiab): a pilot randomised controlled trial of metformin in impaired glucose tolerance after kidney transplantation

“…tacrolimus use. Using OGTT at 1 year as an end point for efficacy would be reasonable as it remains the gold standard for PTDM diagnosis [12], also because the overall rate of PTDM remains largely unchanged beyond 1 year post transplantation [47].…”

Management of metabolic alterations in adult kidney transplant recipients: A joint position statement of the Italian Society of Nephrology (SIN), the Italian Society for Organ Transplantation (SITO) and the Italian Diabetes Society (SID)

“…After the first year post-transplantation, during which PTDM incidence is the greatest [33e37], continuous screening is recommended, at least annually. In fact, glucose metabolism after transplantation is highly dynamic, with glucose metabolism either deteriorating or improving over time in individual patients even after the first year [38], highlighting the need for continuous screening. Although studies with larger sample size and longer follow-up are needed to better evaluate the diagnostic accuracy of FPG and HbA1c after the first year following KT, it seems reasonable to screen patients with FPG and HbA1c annually, unless otherwise indicated based on clinical conditions.…”

Diabetes mellitus vor und nach Nierentransplantation

“…für Prädiabetes bei ca. 20 %, und bleibt auch im Langzeitverlauf nach Transplantation in dieser Größenordnung [12]. Insgesamt liegt die Prävalenz von Störungen im Glukosemetabolismus nach Nierentransplantation bei über 50 % und stellt somit ein entscheidendes Problem dar.…”