Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients

Axelrod, David A.; Cheungpasitporn, Wisit; Bunnapradist, Suphamai; Xiao, Huiling; McAdams-DeMarco, Mara; Çalışkan, Yaşar; Bae, Sunjae; Ahn, JiYoon B.; Segev, Dorry L.; Lam, Ngan N.; Hess, Gregory P.; Lentine, Krista L.

doi:10.1016/j.xkme.2021.08.012

Cited by 13 publications

(17 citation statements)

References 73 publications

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“…Age over 55 years and BMI over 30 have been shown to be major risk factors for post-transplant diabetes [19]. A similar association of age with the development of abnormal glucose metabolism was found in another study, but patients included were older at the time of transplant [20].…”

Section: Discusionsupporting

confidence: 62%

А Prevalence and Risk Factors for Insulin Resistance and Dysglycemia After Kidney Transplantation in Patients on Cyclosporine-a Based Immunosuppression

Petkovska

Simonovska

Babulovska

et al. 2022

JMS

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Glucose disorders and insulin resistance are major factors affecting cardiovascular morbidity after renal transplantation. We analyzed the prevalence of pre-diabetes, increased insulin resistance, the factors for their occurrence, as well as the consequences on graft function in kidney transplant patients who are on a cyclosporine-A based immunosuppressive protocol.59 non-diabetic living donor kidney recipients were included in this cross-sectional and prospective study. All patients were on the same triple immunosuppressive therapy in maintenance doses. OGTT and indices of insulin resistance were analyzed at least 6 months after transplantation, as well as factors for their occurrence. According to the OGTT results, the patients were divided into two groups: a group with dysglycemia and a group of normoglycemic patients. Graft function was controlled after a period of followup.The prevalence of dysglycemia and insulin resistance was 33.9% (20/59) and 86.44% (51/59), respectively. In the group with dysglycemia, insulin resistance was more prevalent 95% (19/20), than betacell hypofunction 40% (8/20). The insulin resistance index in the dysglycemic group was significantly higher (3.139 ± 1.11) versus the normoglycemic group (2.264±1.00), p ˂0.01. The most significant risk factors for increased insulin resistance in the dysglycemic group were: shorter transplant period, higher doses of cyclosporin-A, postload insulin, and insulin secretion index. In this group of patients, a significant decrease in e-GFR was observed after an average of 18 months of follow-up.Insulin resistance is very prevalent after renal transplantation, and especially high in dysglycemic patients, and the associated risk factors are potentially modifiable. OGTT is an important diagnostic tool for assessing the prevalence of occult diabetes and insulin resistance, and its routine application may contribute to reducing their prevalence.

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Section: Discusionsupporting

confidence: 62%

А Prevalence and Risk Factors for Insulin Resistance and Dysglycemia After Kidney Transplantation in Patients on Cyclosporine-a Based Immunosuppression

Petkovska

Simonovska

Babulovska

et al. 2022

JMS

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“…States, approximately 40% of kidney transplant recipients are expected to develop PTDM in the three years following transplantation. 4 The highest incidence of PTDM occurs in the first six months after transplant (12.7-20.5%) 21,22 when immunosuppression doses are highest. 23 While each of reduced insulin sensitivity, increased insulin resistance and decreased insulin secretion are observed, 24 PTDM has been proposed to more reflect beta-cell dysfunction (i.e.…”

Section: Discussionmentioning

confidence: 99%

The Association of Pre-Transplant C-Peptide Level with the Development of Post-Transplant Diabetes: A Cohort Study

et al. 2022

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Background: Post-transplant diabetes mellitus (PTDM) is an important complication after kidney transplantation that results in reduced patient and allograft survival. While there are established risk factors for PTDM, whether pre-transplant C-peptide levels associate with PTDM is unknown. Therefore, in this study we aimed to examine the association of pre-transplant C-peptide levels with PTDM. Methods: This was a cohort study of non-diabetic adult patients who underwent kidney transplant in Nova Scotia, Canada, between 01-01-2016 to 03-31-2021 with fasting C-peptide levels measured prior to transplant. Multivariable logistic regression was used to determine the association of pre-transplant C-peptide (dichotomized around the median) with PTDM at one-year post-transplant. Given the known association between pre-transplant obesity and PTDM, we repeated our primary analysis in a cohort restricted to BMI 20-35 kg/m2. Results: Median C-peptide value was 3251 (Q1 2480, Q3 4724); pre-transplant C-peptide level was dichotomized at 3000 pmol/L. PTDM occurred in 25 individuals (18.9%). 29.6% of patients in the high and only 2.0% of patients in the low C-peptide groups developed PTDM, p-value < 0.001. C-peptide level ≥3000 was strongly associated with PTDM in multivariable analysis (OR 18.9, 95% CI 2.06-174.2). In a restricted cohort with BMI 20-35 kg/m2, an elevated pre-transplant C-peptide remained independently associated with the risk of PTDM (OR 15.7, 95% CI 1.64-150.3). C-peptide was the only factor independently associated with PTDM in this restricted BMI cohort. Conclusions: A pre-transplant C-peptide level ≥3000 pmol/L was associated with a nearly 20-fold increased odds of PTDM at one-year post-kidney transplantation. Identifying patients with high pre-transplant C-peptide levels may therefore help identify those at risk for PTDM who may benefit from focused preventative and therapeutic interventions and support.

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“…PTDM is a significant complication in renal transplant patients with no known history of DM pre-transplant [ 4 , 5 ]. Although PTDM shares a similarity in pathogenesis with Type 2 DM, it has other different mechanisms by which it can cause hyperglycemia [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

New-Onset Diabetes Mellitus in Post-renal Transplant Patients on Tacrolimus and Mycophenolate: A Systematic Review

Nandula¹,

Boddepalli²,

Gutlapalli³

et al. 2022

Cureus

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A frequent complication in kidney transplantation is post-transplant diabetes mellitus (PTDM). The primary goal of this study is to review the risk factors and preventive methods and compare the different available anti-diabetic medications for the management of PTDM. We searched databases like Pubmed and Google Scholar for related articles using specific terms and phrases. Following a thorough investigation, we applied the inclusion and exclusion criteria and completed a quality assessment.Modifiable risk factors have a significant role in the development of PTDM. The combinations of immunosuppressive treatment tacrolimus (TAC), cyclosporine A (CYC), and everolimus (EVL), steroids increase the incidence of PTDM significantly. Insulin is the most effective treatment for PTDM in the early transplant period; however, oral anti-diabetic medications look promising. Further clinical trials are required to determine the optimum treatment method for reducing the occurrence of PTDM and treating the existing condition with novel anti-hyperglycemic medications.

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Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Recipients

Cited by 13 publications

References 73 publications

А Prevalence and Risk Factors for Insulin Resistance and Dysglycemia After Kidney Transplantation in Patients on Cyclosporine-a Based Immunosuppression

А Prevalence and Risk Factors for Insulin Resistance and Dysglycemia After Kidney Transplantation in Patients on Cyclosporine-a Based Immunosuppression

The Association of Pre-Transplant C-Peptide Level with the Development of Post-Transplant Diabetes: A Cohort Study

New-Onset Diabetes Mellitus in Post-renal Transplant Patients on Tacrolimus and Mycophenolate: A Systematic Review

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