Risk Factors and Outcomes Associated with Posttransplant Diabetes Mellitus in Kidney Transplant Recipients

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Risk Factors and Outcomes Associated with
Posttransplant Diabetes Mellitus in Kidney
Transplant Recipients

• Reference Siraj ES, Aßacan C, Chinnappa P, et
  al. Risk factors and outcomes associated with
• post-transplant diaßetes mellitus in kidney
  transplant recipients. Transplant Proc.
  20104216851689.

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Diaßetes Mellitus The Foremost Complication
after Renal Transplantation

• The occurrence of diaßetes mellitus after kidney
  transplantation is considered to ße a serious
  complication.
• In the previous era, the prevalence of
  posttransplant diaßetes mellitus (PTDM) was 100.

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Risk Factors for Posttransplant Diaßetes Mellitus

• Many factors have ßeen found to ße responsißle
  for the development of PTDM
• Advanced age, family history of diaßetes, ßlack
  and Hispanic ethnicity, previous history of
  aßnormal glucose tolerance, use of tacrolimus for
  immunosuppression and high-dose steroids.
• Diagnoses of hepatitis C virus infection ßefore
  transplantation.
• Higher ßody mass index (ßMI) cadaveric donor and
  certain human leukocyte antigen types.

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Impact of Posttransplant Diaßetes Mellitus

• Patients who have developed PTDM have ßeen
  diagnosed with either insulin resistance or
  ß-cell dysfunction.
• Posttransplant diaßetes mellitus was defi ned ßy
  the American Diaßetes Association as criteria of
  a fasting ßlood glucose level ?126 mg/dL or
  random ßlood glucose level ?200 mg/dL.
• Diabetes after transplantation has a negative
  impact on graft survival as well as patient
  survival. In addition to this, PTDM is associated
  with the risk of infections as well as
  cardiovascular disease.

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• Keeping this in view, a study was conducted to
  examine the risk factors and the outcomes
  associated with PTDM in patients with renal
  transplantation.
• The study enrolled 209 charts of 217 single-organ
  kidney transplant recipients transplanted between
  January 1996 and December 1998.
• Among these 217 single-organ kidney transplant
  recipients, 49 of them developed PTDM who were
  considered as cases and were compared with the 49
  controls.
• The primary effi cacy parameters assessed were
  demographic data, risk factors for the
  development of PTDM, use of immunosuppressants
  and outcomes and complications.

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Clinical Outcomes of the Study

• Occurrence of PTDM was signifi cantly associated
  with age ?40 years, BMI ?30 kg/m2, presence of
  pretransplant triglyceride level gt150 mg/dL and
  presence of rejection after transplant.
• Pretransplant triglyceride levels and smoking are
  also considered to be potential risk factors for
  PTDM.
• Figure 1 depicts some of the most important risk
  factors in both the groups.
• Occurrence of PTDM was clearly associated with
  increased risk of cardiovascular complications,
  infections and graft rejection.
• Complications that showed some trend included
  peripheral vascular disease, death and the
  presence of proteinuria.
• There was no association of creatinine levels
  with PTDM.
• Figure 2 compares some of the most important
  complications in both cases and controls.

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• In addition to the above parameters, the authors
  performed a detailed study about the
  cardiovascular complications and revealed that
  myocardial infarction and angina to be the most
  common complications occurring in patients with
  PTDM.
• In addition to these, angioplasty, stent
  placement and coronary artery bypass grafting
  procedures, as well as cardiovascular deaths were
  also involved.

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Conclusion

• Occurrence of PTDM is higher than previously
  reported.
• Posttransplant diabetes mellitus leads to
  cardiovascular complications, infections and
  rejection episodes.
• Pretransplant patients should be properly
  screened for the PTDM risk factors.
• Patients with a high-risk of PTDM should be
  closely monitored after transplant and should be
  aggressively treated if they develop diabetes to
  minimize the risk of complications.