Risk Factors in and Long-Term Survival of Patients with Post-Transplantation Diabetes Mellitus: A Retrospective Cohort Study

Abstract

Post-transplant diabetes mellitus (PTDM) is associated with infection, cardiovascular morbidity, and mortality. A retrospective cohort study involving patients who underwent renal transplantation in a transplantation center in Taiwan from January 2000 to December 2018 was conducted to investigate the incidence and risk factors of PTDM and long-term patient and graft survival rates. High age (45–65 vs. <45 years, adjusted odds ratio (aOR) = 2.90, 95% confidence interval (CI) = 1.64–5.13, p < 0.001), high body mass index (>27 vs. <24 kg/m2, aOR = 5.35, 95% CI = 2.75–10.42, p < 0.001), and deceased organ donor (cadaveric vs. living, aOR = 2.01, 95% CI = 1.03–3.93, p = 0.04) were the three most important risk factors for the development of PTDM. The cumulative survival rate of patients and allografts was higher in patients without PTDM than in those with PTDM (p = 0.007 and 0.041, respectively). Concurrent use of calcineurin inhibitors and mammalian target of rapamycin inhibitors (mTORis) decreased the risk of PTDM (tacrolimus vs. tacrolimus with mTORi, aOR = 0.28, 95% CI = 0.14–0.55, p < 0.001). Investigating PTDM risk factors before and modifying immunosuppressant regimens after transplantation may effectively prevent PTDM development.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2022

“…Although the use of immunosuppressive therapies is a major contributor to the development of PTDM, the risks of transplant rejection outweigh the risks of PTDM and the role of the diabetes care provider is to treat hyperglycemia appropriately regardless of the type of immunosuppression (143) risks (such as age, family history of diabetes, etc.) as well as transplant-specific factors, such as use of immunosuppressant agents (148)(149)(150). Whereas posttransplantation hyperglycemia is an important risk factor for subsequent PTDM, a formal diagnosis of PTDM is optimally made once the patient is stable on maintenance immunosuppression and in the absence of acute infection (146)(147)(148)151).…”

New-Onset Diabetes after Kidney Transplantation

“…CVD undoubtedly represents the most relevant and dreadful complication of NODAT [ 43 , 44 , 45 , 46 , 47 , 48 ]. However, especially in the long term, NODAT may also cause progressive diabetic kidney disease, including glomerular, tubulointerstitial, and/or vascular lesions, as well as proteinuria [ 49 ].…”

“…However, in comparison with diabetic nephropathy in native kidneys, NODAT is more frequently associated with vascular or tubulointerstitial changes caused by rejection, viral infection, drug nephrotoxicity, or poor quality of the donated kidney. The synergistic effect of these changes may explain a deleterious impact of NODAT on long-term graft survival [ 46 , 47 , 48 , 51 ].…”

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

“…Previously, described as “new-onset diabetes after transplantation” (NODAT), the condition is now called post-transplant DM (PTDM) in recognition of the fact that in some cases DM may have not been diagnosed before transplantation [ 6 ]. According to estimates, the incidence of PTDM ranges from 9.1 to 45.3% after 1 year, 10 to 30.0% after 3 years, and 10.2 and 15.1% after 5 years of transplantation [ 7 ]. 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 ].…”