Posttransplant Increase of Body Mass Index is Associated with New-Onset Diabetes Mellitus after Kidney Transplantation

Abstract

New-onset diabetes after transplantation (NODAT) is a serious complication after kidney transplantation. Obesity was widely identified as a modifiable risk factor for NODAT. Body mass index (BMI) is the most frequently used diagnostic indication of obesity, and higher pretransplant BMI has been reported to be an independent risk factor of NODAT. However, the influence of posttransplant increase in BMI on the development of NODAT during outpatient follow-up has not been established. This is a single-centered retrospective study in Japan. We identified 158 consecutive patients who received living donor kidney transplantation in Sendai Shakaihoken Hospital from September 2000 to December 2009. Of these, 101 patients were included in this study. NODAT was defined based on the American Diabetes Association definitions. Fifteen patients developed NODAT with a median follow-up period of 27 (3-109) months. Of these 15 patients with NODAT, 13 patients were diagnosed after the first year of transplantation, with a median follow-up of 29 months, and 2 patients were diagnosed at 3 months after transplantation. Recipient age (HR: 1.06 [1.01-1.13]) and increase in BMI (HR: 1.12 [1.01-1.26]) proved to be independent risk factors of NODAT in multivariate logistic analysis after adjustments for pretransplant 2-hour OGTT level, pretransplant BMI, and use of tacrolimus. This is the first study showing the association between an increase in BMI and the development of NODAT. The increase in BMI might be a risk factor for NODAT. These findings underline the importance of routine BMI measurements in medical practice.

Prevalence and risk factors of new-onset diabetes after transplantation: A single-center experience

“…In the retrospective study conducted by Tokodai and colleagues on 158 kidney transplant patients, a significant relationship was found between the increase in BMI and the development of NODAT [15]. In our study, univariate analyses revealed that the pre-transplant BMI value was statistically higher in patients who developed NODAT compared to those who did not.…”

Post-Liver Transplantation Diabetes Mellitus: A Review of Relevance and Approach to Treatment

“…As in the general population, lifestyle modifications are the cornerstone of PLTDM prevention in LT recipients. The positive association between post-transplant BMI increment and risk of subsequent DM [ 107 ] justifies advising weight loss to LT recipients, although this should not be encouraged immediately after surgery to avoid a negative effect on wound healing [ 106 ]. Exercise or an increase in daily life physical activity should also be recommended [ 106 ].…”

Pre-Transplant HbA1c Is a Useful Predictor for the Development of New-Onset Diabetes in Renal Transplant Recipients Receiving No or Low-Dose Erythropoietin.

“…Several clinical trials have revealed that lifestyle-change interventions were effective in preventing type 2 diabetes mellitus [6,7] and that they may be applicable in NODAT cases too. We previously reported that the posttransplant increase in body mass index and body fat percentage is associated with the development of NODAT [8,9], indicating that lifestyle-change interventions are useful for preventing NODAT.…”

“…In our previous study, all patients who developed NODAT had received tacrolimus-based immunosuppressive treatment [8]. Hence, in this study, we evaluated the predictive power of the pretransplant HbA1c level for the development of NODAT in patients receiving tacrolimus-based immunosuppressive treatment.…”