Risk Factors and Outcomes of New-Onset Diabetes After Transplant: Single-Centre Experience

Abstract

Objectives: We sought to study the prevalence, risk factors, and long-term prognosis of posttransplant diabetes mellitus. Materials and Methods:We studied all patients with end-stage renal disease without diabetic nephropathy who received a kidney transplant and were followed-up at our center since 1983 (n=218; age, 44.3 ± 13.1 y). Patients with new-onset diabetes after transplant were compared to kidney transplant recipients without risk factors for diabetes mellitus. Patients with new-onset diabetes after transplant were divided into subgroups according to time of onset (early; < 90 d vs late, ≥ 90 d).Results: In total, 73/218 patients (33%) developed new-onset diabetes after transplant. Patients with new-onset diabetes after transplant were significantly older (51.2 ± 11.4 vs 40.7 ± 12.5 y; P < .001) and had a tendency to have a higher body mass index (29.6 ± 8.7 vs 21.6 ± 7.8 kg/m 2 ; P =.05) than those that did not have new-onset diabetes after transplant. In multivariate analysis, age (P < .001), hepatitis C virus infection (P < .05), family history of diabetes mellitus (P < .03), and tacrolimus use (P < .001) were independent risk factors. Fiveand 10-year death censored patient survival rates were worse in those that had new-onset diabetes after transplant compared with controls (log rank, 0.04), whereas there was no difference in outcomes between the early and late subgroups. Conclusions:The prevalence of new-onset diabetes after transplant was 33%. Age, body weight at time of transplant, tacrolimus use, family history of diabetes mellitus, and hepatitis C virus infection are independent risk factors for new-onset diabetes after transplant. New-onset diabetes after transplant has a negative effect on patient survival, irrespective of the time of onset and duration of diabetes.

Effects of preoperative hepatitis B virus infection, hepatitis C virus infection, and coinfection on the development of new‐onset diabetes after kidney transplantation

“…Results from other studies indicating a comparable incidence of NODAT among KTRs with or without HCV infection may be less reliable for excluding various confounders . The present study suggests a significant role of HCV infection in NODAT development, which is in accordance with results from other studies . A meta‐analysis provided retrospective evidence of a 3.97‐fold increased risk of NODAT in HCV‐infected KTRs .…”

“…23,24,26 The present study suggests a significant role of HCV infection in NODAT development, which is in accordance with results from other studies. 2,4,20 A meta-analysis provided retrospective evidence of a 3.97-fold increased risk of NODAT in HCVinfected KTRs. 1 Successful anti-HCV therapy was reported to greatly ameliorate glucose dysregulation, 37 which supports the findings of the present study.…”

“…17 Considering the adverse consequences following NODAT, it is important that the association between HBV and HCV infection and incident NODAT in KTRs is well established. However, limited studies on HBV infection and incident NODAT are available to establish a reliable association between the two; it remains contentious whether HCV infection increases the risk of NODAT, with some studies reporting a significant correlation between the two, 2,4,[18][19][20][21] and others indicating no consistent association. [22][23][24][25][26] Moreover, whether coinfection with HBV and HCV exerts a greater effect on the development of NODAT than infection with each virus individually remains unclear due to the scarcity of relevant information.…”

Hepatitis C Virus Infection and Kidney Transplantation in 2014: What’s New?

“…The frequency of HCV‐associated NODAT is higher when traditional risk factors such as high BMI, metabolic syndrome, a positive family history for diabetes mellitus, older age and ethnicity (Hispanic or African‐American) are present . In HCV‐infected recipients, NODAT manifests usually in the first months after transplantation when higher doses of immunosuppressants are administered .…”

Prevalence of New Onset Diabetes in Patients After Kidney Transplantation – The Prospective Study

“…Clinical studies indicate that tacrolimus (TAC) is associated with a higher risk for IGT and NODAT than is cyclosporine. It is not defined whether the effect of CNI on glucose metabolism is dosage-dependent (4). A large retrospective registry showed that new onset diabetes after kidney transplantation is a significant, independent predictor of total mortality and loss of graft function.…”