Increasing Incidence of New-Onset Diabetes After Transplant Among Pediatric Renal Transplant Patients

Abstract

Background Risk of new-onset diabetes after transplant (NODAT) is well characterized for adults but much less understood in pediatric transplant. This study examines the incidence and risk factors of NODAT in pediatric renal transplant patients. Methods The incidence of NODAT over the first three years following transplant were examined with United States Renal Data System data for primary renal transplant recipients (ages 0–21 years, transplanted between 1995 and 2004) with Medicare primary. Patients had no evidence of diabetes prior to transplant. We estimated the cumulative incidence rate and used Cox proportional hazards regression to identify risk factors for NODAT. Propensity scores were calculated for immunosuppression choice to adjust for potential confounding factors. Results 2168 recipients with valid immunosuppression records and without pretransplant evidence of diabetes were included. Unadjusted, cumulative NODAT incidence at three years posttransplant was 7.1%. Significant factors for increased risk of NODAT included Cytomegalovirus D+/R− serostatus (adjusted hazard ratio (aHR)=1.60), age 13–18 years (aHR=2.18), age 19–21 years (aHR=2.60), body mass index ≥ 30 (aHR=2.17) and use of tacrolimus (aHR=1.51). We failed to find any significant relationships between NODAT and graft failure/death. Conclusions While the incidence of NODAT among patients 0–21 years of age is lower than that for adult patients, it is higher than suggested by earlier research and may represent an increase over time. The lack of association between NODAT and graft/failure death has important implications for post-transplant care. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.

Hypomagnesemia and increased risk of new-onset diabetes mellitus after transplantation in pediatric renal transplant recipients

“…These include increasing age, BMI, tacrolimus exposure and primary CMV mismatch [2]. Some of these risk factors were corroborated in the current study, whilst others were not replicated in our data.…”

“…It compromises both renal transplant and patient survival [1]. The incidence of NODAT is increasing in pediatric renal transplant recipients, although it remains less prevalent than in the adult population [2]. NODAT adds to the burden of cardiovascular disease observed in children following kidney transplantation [3, 4].…”

“…Known risk factors for NODAT in pediatric kidney transplant recipients include increasing age, body mass index (BMI) of >30 kg/m 2 , tacrolimus exposure and primary cytomegalovirus (CMV) mismatch [2]. …”

Sirolimus in pediatric renal transplantation

“…PTDM. PTDM incidence in pediatric RTR varies between 2% and 20% in different series (102–107), which increases as the age of the transplanted child increases. The rate of PTDM is considerably higher than the rate of diabetes among non‐transplant children in the general population (0.18%) (108).…”

“…The rate of PTDM is considerably higher than the rate of diabetes among non‐transplant children in the general population (0.18%) (108). The risk factors for PTDM in pediatric RTR are black race, older age, obesity (BMI ≥ 30), steroid dose and use of TAC and the state of cytomegalovirus D+/R− (102, 103).…”