Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

Dienemann, Thomas; Fujii, Naohiko; Li, Yimei; Govani, Shivali; Kosaraju, Nikitha; Bloom, Roy D.; Feldman, Harold I.

doi:10.1111/tri.12807

Cited by 34 publications

(23 citation statements)

References 26 publications

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“…How and when to screen for hyperglycemia during the unstable post‐transplant phase [32,33], and the best way to identify patients at risk (previous recommendations 3 and 4) are therefore not trivial issues. However, the fact that there truly is an increased risk of mortality in kidney transplant recipients [34], especially if they have treated PTDM [35,36], and that this mortality risk is most likely due to cardiovascular causes [3‐5,31,37,38], is by now well established.…”

Section: Introductionmentioning

confidence: 99%

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%

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

et al. 2020

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“… 4 Importantly, PTDM is an established risk factor for cardiovascular disease and mortality, and accordingly, is associated with increased health care costs. 5 , 6 , 7 , 8 However, few studies have been designed to prevent this condition. 9 …”

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confidence: 99%

Randomized Controlled Trial Assessing the Impact of Tacrolimus Versus Cyclosporine on the Incidence of Posttransplant Diabetes Mellitus

Torres

Hernández

Moreso

et al. 2018

Kidney International Reports

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IntroductionDespite the high incidence of posttransplant diabetes mellitus (PTDM) among high-risk recipients, no studies have investigated its prevention by immunosuppression optimization.MethodsWe conducted an open-label, multicenter, randomized trial testing whether a tacrolimus-based immunosuppression and rapid steroid withdrawal (SW) within 1 week (Tac-SW) or cyclosporine A (CsA) with steroid minimization (SM) (CsA-SM), decreased the incidence of PTDM compared with tacrolimus with SM (Tac-SM). All arms received basiliximab and mycophenolate mofetil. High risk was defined by age >60 or >45 years plus metabolic criteria based on body mass index, triglycerides, and high-density lipoprotein–cholesterol levels. The primary endpoint was the incidence of PTDM after 12 months.ResultsThe study comprised 128 de novo renal transplant recipients without pretransplant diabetes (Tac-SW: 44, Tac-SM: 42, CsA-SM: 42). The 1-year incidence of PTDM in each arm was 37.8% for Tac-SW, 25.7% for Tac-SM, and 9.7% for CsA-SM (relative risk [RR] Tac-SW vs. CsA-SM 3.9 [1.2–12.4; P = 0.01]; RR Tac-SM vs. CsA-SM 2.7 [0.8–8.9; P = 0.1]). Antidiabetic therapy was required less commonly in the CsA-SM arm (P = 0.06); however, acute rejection rate was higher in CsA-SM arm (Tac-SW 11.4%, Tac-SM 4.8%, and CsA-SM 21.4% of patients; cumulative incidence P = 0.04). Graft and patient survival, and graft function were similar among arms.ConclusionIn high-risk patients, tacrolimus-based immunosuppression with SM provides the best balance between PTDM and acute rejection incidence.

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“…PTDM affects not only patient outcome [1] but also, via death with a functioning graft, allograft survival [2]. Incident PTDM within the first year after kidney transplantation doubles long-term mortality [3].…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Glucose Metabolism After Kidney Transplantation

Guthoff¹,

Wagner²,

Weichbrodt³

et al. 2017

Kidney Blood Press Res

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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.

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Long-term patient survival and kidney allograft survival in post-transplant diabetes mellitus: a single-center retrospective study

Cited by 34 publications

References 26 publications

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

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

Randomized Controlled Trial Assessing the Impact of Tacrolimus Versus Cyclosporine on the Incidence of Posttransplant Diabetes Mellitus

Dynamics of Glucose Metabolism After Kidney Transplantation

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