J Korean Soc Transplant.  2007 Dec;21(2):262-268.

Development and Clinical Implication of Post- transplant Diabetes Mellitus

Affiliations
  • 1Department of Surgery, Dankook University College of Medicine, Cheonan, Korea.
  • 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. jwhamd@snu.ac.kr
  • 3Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 4The Transplantation Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Abstract

PURPOSE: It has been known that the incidence of post-transplant diabetes mellitus (PTDM) is variable according to the immunosuppressant used. The goals of this study are to uncover the factors associated with the development of PTDM and to clarify the fate of PTDM.
METHODS
The medical records of 267 patients who underwent renal transplant between 1996 and December 2002 at Seoul National University Hospital were retrospectively reviewed. Patients were divided into three groups: cyclosporine group (CsA, n=179), high tacrolimus group (HFK, mean trough level during post-transplant 2 week>15 ng/m, n=33) and low tacrolimus group (LFK, mean trough level during post- transplant 2 week< or =15 ng/mL, n=55). The incidence, risk factors of PTDM and clinical fate were analyzed.
RESULTS
PTDM developed in 46 (17.2%) patients. PTDM incidence of HFK group (60.6%) was significantly higher than CsA group (10.1%) and LFK group (14.5%) (P=0.000). Tacrolimus use, age at the time of transplantation (>40year), family history of diabetes and obesity (BMI>25) were the risk factors for PTDM development. Incidences of associated clinical events, such as acute rejection, cerebrovascular accident, myocardial infarction, or infection were not different between PTDM and non-PTDM group. PTDM was resolved in 13 out of 46 patients (28.3%). Only 7 out of 33 patients (21.2%) in whom PTDM persisted lost their graft.
CONCLUSION
PTDM incidence was higher in HFK group. So, LFK protocol is considered to be safe and beneficial, at least in terms of PTDM. Tacrolimus as immunosuppressant, recipient, family history of DM and obesity were the risk factors of PTDM development. PTDM was reversible in 28.3% of patients. PTDM had little impact on clinical outcomes during mid-term period.

Keyword

PTDM; Immunosuppression; Risk factor

MeSH Terms

Cyclosporine
Diabetes Mellitus*
Humans
Immunosuppression
Incidence
Medical Records
Myocardial Infarction
Obesity
Retrospective Studies
Risk Factors
Seoul
Stroke
Tacrolimus
Transplants
Cyclosporine
Tacrolimus
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