Post Transplant Diabetes Mellitus in Pediatric Renal Transplant Recipients: A Report of the North American Pediatric Renal Transplant Cooperative Study (Naprtcs)

Al-Uzri, A.; Cohn, Richard A.; Sullivan, E K

doi:10.1097/00007890-199806270-00077

Cited by 1 publication

(4 citation statements)

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“…However, the incidence of pediatric PTDM is significantly increasing with time: 2.1% (1986–1990), 3.7% (1991–1995), 20% (1996–1999) (11); it is still much lower than in adults. Two large‐cohort studies were able to identify PTDM after renal transplantation in as low as 2.6% (12) and 7.1% (13) of the children (vs. in 4.7–11.5% of the adults). In the light of these findings, one can conclude that although the rate of PTDM in children is lower than in their adult counterparts, it deserves special attention.…”

Section: Pediatric Aspectmentioning

confidence: 99%

“…The North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), a large‐scale study on 1365 renal transplant children, has shown that the main daily dose of prednisone 30 d after transplantation was significantly higher in the PTDM group vs. controls and they concluded that the use of higher dose prednisolone in the first 6 months can play a significant role in the development of PTDM (12). In line with these results, the Organ Procurement Transplant Network/United Network of Organ Sharing database, including 2726 primary kidney transplant children, identified steroid use at discharge as an independent risk factor for the development of PTDM (29).…”

Section: Corticosteroidsmentioning

confidence: 99%

“…The pathophysiology how to induce carbohydrate metabolism disorders in some cases is well known while in some other risk factors (e.g., cadaver donor) we may only speculate. Furthermore, there are some special pediatric risks for the development of PTDM meriting attention, such as the concomitant growth hormone treatment (84), the age of adolescence (12), the cystic fibrosis (85), and the ‘renal cysts and diabetes' syndrome (86–88). Taken together, all these risk factors further facilitate the diabetogenic effect of standard immunosuppressive drugs and increase the incidence of PTDM among solid‐organ transplant patients.…”

Section: Other Risk Factorsmentioning

confidence: 99%

“…On the basis of US Renal Data System, 2168 children have shown significant susceptibility for developing PTDM associated with Tac therapy (13). The North American Pediatric Renal Transplant Cooperative Study on 1365 renal transplant children also showed that Tac use was disproportionately higher (45%) and insulin treatment was longer in the PTDM group (12). Along these lines, it has been shown that Tac therapy is associated with a higher incidence of glucose intolerance + PTDM (7.1 vs. 18.1%, CyA vs. Tac) in 1611 liver transplant children (SPLIT database) (26).…”

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confidence: 99%

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The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus

et al. 2011

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Solid-organ transplantation is the optimal long-term treatment for most patients with end-stage organ failure. After solid-organ transplantation, short-term graft survival significantly improved (1). However, due to chronic allograft nephropathy and death with functioning graft, long-term survival has not prolonged remarkably (2). Posttransplant immunosuppressive medications consist of one of the calcineurin inhibitors in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroids. All of them have different adverse effects, among which posttransplant diabetes mellitus (PTDM) is an independent risk factor for cardiovascular (CV) events and infections causing the death of many transplant patients and it may directly contribute to graft failure (3). According to the criteria of the American Diabetes Association (4), diabetes mellitus (DM) is defined by symptoms of diabetes (polyuria and polydipsia and weight loss) plus casual plasma glucose concentration ≥ 11.1 mmol/L or fasting plasma glucose (FPG) ≥ 7.0 mmol/L or 2-h plasma glucose level ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). This metabolic disorder occurring as a complication of organ transplantation has been recognized for many years. PTDM, which is a combination of decreased insulin secretion and increased insulin resistance, develops in 4.9/15.9% of liver transplant patients, in 4.7/11.5% of kidney recipients, and in 15/17.5% of heart and lung transplants [cyclosporine A (CyA)/tacrolimus (Tac)-based regimen, respectively] (5). Risk factors of PTDM can be divided into non-modifiable and modifiable ones (6), among which the most prominent is the immunosuppressive therapy being responsible for 74% of PTDM development (7). Emphasizing the importance of the PTDM, numerous studies have determined the long-term outcome. On the basis of these studies, graft and patient survival is tendentiously (8) or significantly (9, 10) decreased for those developing PTDM.

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Section: Pediatric Aspectmentioning

confidence: 99%

Section: Corticosteroidsmentioning

confidence: 99%