Risk factors for new‐onset diabetes mellitus after kidney transplantation: A systematic review and meta‐analysis

Abstract

Aims/Introduction: To systematically review the risk factors for new-onset diabetes mellitus after kidney transplantation, and to provide a theoretical basis for the prevention and management of new-onset diabetes mellitus after kidney transplantation. Materials and Methods: We searched PubMed, Web of Science, Embase, the Cochrane Library databases and other databases for case-control studies related to risk factors for newonset diabetes mellitus after kidney transplantation published between January 2005 and July 2019. A meta-analysis of data on risk factors for new-onset diabetes mellitus after kidney transplantation from the included studies was carried out. A narrative review of risk factors for new-onset diabetes mellitus after kidney transplantation was also carried out. Results: A total of 24 case-control studies were included in the meta-analysis, with a total of 7,140 patients. There were 1,598 patients with new-onset diabetes mellitus after kidney transplantation, and 5,542 patients without new-onset diabetes mellitus after kidney transplantation. The meta-analysis results showed that age, polycystic kidney disease, family history of diabetes, body mass index, acute rejection, tacrolimus use, hepatitis B virus infection, hepatitis C virus infection and hypertension were associated with new-onset diabetes mellitus after kidney transplantation, whereas sex, sirolimus use, cyclosporin A use, steroid use and cytomegalovirus infection were not associated with new-onset diabetes mellitus after kidney transplantation. Conclusions: Older age, body mass index, family history of diabetes, tacrolimus use, history of hypertension, polycystic kidney disease, acute rejection, hepatitis B virus infection and hepatitis C virus infection are risk factors for new-onset diabetes mellitus after kidney transplantation. Therefore, the clinical implications of these factors warrant attention.

Impact of diabetes mellitus developing after kidney transplantation on patient mortality and graft survival: a meta-analysis of adjusted data

“…While the traditional risk factors for DM also apply to PTDM, some specific risk factors about the transplant procedure can additionally increase the risk for PTDM [ 6 ]. In a recent systematic review and meta-analysis of 24 case–control studies, Xia et al [ 8 ] have identified advanced age, body mass index, family history of diabetes, tacrolimus use, history of hypertension, polycystic kidney disease, acute rejection, hepatitis B virus infection, and hepatitis C virus infection as risk factors for PTDM.…”

“…Despite the intense research on the pathophysiology and risk factors for PTDM [ 8 , 9 ], it is still unclear how this complication impact patient outcomes. Some studies have reported no impact of PTDM on patient and graft survival [ 10 – 14 ] while others indicate that mortality and graft failure is significantly increased with PTDM [ 15 – 18 ].…”

Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation

“…Finally, in a meta-analysis that included 21 retrospective observational studies with a patient sample size of 241,381, obese recipients showed a higher risk of having biopsy-proven acute rejection and delayed graft function, compared with their healthy BMI counterparts [ 49 ].…”

Obesity and bariatric surgery in kidney transplantation: A clinical review

“…Obesity may increase the risk of cardiovascular complications, DM, and metabolic syndrome, which are well-known posttransplant complications related to the chronic use of immunosuppression[ 4 - 9 ]. However, data on the clinical outcomes of kidney transplantation in obese patients are conflicting due to the lack of consensus on a commonly accepted definition of obesity and on a standard approach to obesity assessment[ 3 ].…”

“…However, data on the clinical outcomes of kidney transplantation in obese patients are conflicting due to the lack of consensus on a commonly accepted definition of obesity and on a standard approach to obesity assessment[ 3 ]. Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates, including dietary education and lifestyle modifications[ 3 - 9 ]. For those failing nutritional restriction and medical therapy, bariatric surgery has recently emerged as a valid therapeutic approach for improving access to kidney transplantation as well as posttransplant outcomes.…”