Posttransplant Diabetes Mellitus in Renal Allograft Recipients: A Prospective Multicenter Study at 2 Years

• Published in: Transplantation proceedings 2006-12, Vol.38 (10), p.3530-3532
• Main Authors: Marcén, R., Morales, J.M., del Castillo, D., Campistol, J.M., Serón, D., Valdés, F., Anaya, F., Andrés, A., Arias, M., Bustamante, J., Capdevila, L., Escuin, F., Gil-Vernet, S., Gonzalez-Molina, M., Lampreave, I., Oppenheimer, F., Pallardó, L.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Biological and medical sciences; Body Mass Index; Diabetes Mellitus - epidemiology; Diabetes. Impaired glucose tolerance; Drug Therapy, Combination; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppressive Agents - therapeutic use; Incidence; Kidney Transplantation - adverse effects; Male; Medical sciences; Middle Aged; Postoperative Complications - epidemiology; Prospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology; Transplantation, Homologous
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2006.10.033

The purpose of this study was to investigate the incidence and risk factors for the development of diabetes mellitus after kidney transplantation (PTDM). A total of 1783 nondiabetic renal allograft recipients transplanted from January 2000 to December 2002 were included. Diabetes was diagnosed following American Diabetes Association criteria. While 1276 patients were treated with tacrolimus (Tac), mycophenolate mofetil (MMF), and steroids, 507 patients received cyclosporine-ME (CsA), MMF, and steroids. PTDM incidence at 6, 12, and 24 months was 14.2%, 12.8%, and 13.3%, respectively. Cumulative incidence during the follow-up was 21.6%. Only 121 of the diabetic patients (47.6%) at 6 months remained diabetic at 24 months. Furthermore, 60 patients of 116 patients on insulin at 6 months (51.7%) remained on treatment at 24 months. The cumulative incidence of PTDM was similar in the two immunosuppressive treatments (19.7% on CsA-MMF vs 22.3% on Tac-MMF; P = NS). However, at 24 months, 14 of 50 diabetic patients on CsA-MMF (28%) and 74 of 161 patients on Tac-MMF (45.9%) were on insulin treatment ( P < .05). By Cox regression analysis, age older than 60 years (RR 1.61; 95%CI 1.28–2.04; P < .001), body mass index (BMI) > 30 kg/m 2 at transplantation (RR 1.66; 95%CI 1.27–2.16; P < .001), and immunosuppression with Tac (RR 1.30; 95%CI 1.02–1-66; P = .033) were associated with PTDM. In conclusions, the incidence of PTDM at 24 months in immunosuppressive protocols including MMF is about 22%, and it is associated with older age, increased BMI, and immnunosuppression with Tac.