Risk Factors of Post-transplantation Diabetes Mellitus in Renal Transplant Recipients

Kang, Wook Ho; Kim, Myoung Soo; Ju, Man Ki; Chang, Hye Kyung; Ahn, Hyung Joon; Kim, Soon Il; Kim, Yu Seun

Abstract

PURPOSE: The aim of this study was to assess the incidence of post-transplantation diabetes mellitus (PTDM) in renal allograft recipients and investigate the risk factors contributing to the development and progression of PTDM and its underlying pathogenic mechanism(s).
METHODS
We analyzed the incidence and risk factors of PTDM after renal transplantation, retrospectively. A total of 913 renal transplant recipients with normal glucose tolerance (NGT) were enrolled. The recipient who needs medical treatment of hyperglycemia more than one month was considered as PTDM patient. We classified PTDM as early PTDM (within post-Tx 1 year) and late PTDM.
RESULTS
Two hundred seven cases of PTDM were developed (22.7%) out of 913 patients. The cumulative incidence of PTDM was 9.4%, 20.5% and 29.0% at post-transplantation 1-, 5- and 10 year respectively. In uni-variate and multivariate analysis of PTDM onset, elderly recipients, tacrolimus-based immunosuppressive group and hepatitis B virus carrier group showed significantly higher incidence of PTDM. Among 207 cases of PTDM, early and late PTDM were 85 cases and 122 cases respectively. The late PTDM developed persistently after post-transplant 5 years. In risk factor analysis of early and late PTDM, late PTDM showed different results compared to early PTDM. The clinical conditions that cause larger dose or high level of calcineurin inhibitor (CNI), such as double immunosuppressive regimen group, induction immunosuppressive therapy-free group and unrelated donor transplant group, were a significant independent risk factor of late PTDM.
CONCLUSION
Our data showed clinical clues that persistent cumulative CNI exposure was correlated with onset of late PTDM. Careful selection of immunosuppressive regimen in high-risk recipients such as elderly patients and hepatitis B virus carrier may decrease the development of PTDM.