Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age.
BACKGROUND
Retrospective studies on the prevalence of posttransplant diabetes mellitus (PTDM) in patients on triple-drug immunosuppressive therapy have shown great dispersity, while the incidence of posttransplant impaired glucose tolerance (IGT) is unknown. The aim of our study was to prospectively examine the incidence of posttransplant glucose intolerance and to assess potential risk factors.


METHODS
Glucose intolerance was prospectively examined in 173 consecutive kidney transplant recipients by oral glucose tolerance tests (n=167) or the diagnosis of manifest diabetes mellitus (n=6) at 10 weeks after transplant.


RESULTS
We found a high incidence of PTDM (18%) and IGT (31%). Univariate analysis revealed that age, family history of diabetes, HLA-B27 phenotype, DR mismatch, rejection, actual prednisolone dose, total methylprednisolone dose, total steroid dose, cytomegalovirus (CMV) infection, and the use of furosemide were associated with PTDM. Age, prednisolone dose, CMV infection, and the use of beta-blockers were associated with IGT. Gender, body mass index, donor source, and cyclosporine level did not influence glucose tolerance. Prednisolone dose, age, family history of diabetes, CMV infection, and HLA-B27 phenotype were independent predictors of PTDM with the use of multiple stepwise logistic regression analysis. Age, prednisolone dose, and the use of a beta-blocker were associated with IGT in the multivariate model. Both univariate and multivariate linear regression analysis revealed a significant relationship between the 2-hr serum glucose and prednisolone dose. The risk of developing PTDM was 5% per 0.01 mg/kg/day of increase in prednisolone dose.


CONCLUSIONS
Increased prednisolone dose and older age are strongly associated with the development of posttransplant glucose intolerance.
Hjelmesaeth
J
J
Medical Department B, National Hospital, University of Oslo, Norway.
Hartmann
A
A
Kofstad
J
J
Stenstrøm
J
J
Leivestad
T
T
Egeland
T
T
Fauchald
P
P
D000328:Adult; D000367:Age Factors; D016572:Cyclosporine / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000235:genetics; D004305:Dose-Response Relationship, Drug; D005190:Family; D005260:Female; D018149:Glucose Intolerance / Q000453:epidemiology* / Q000209:etiology; D006084:Graft Rejection / Q000453:epidemiology; D015796:HLA-B27 Antigen / Q000032:analysis; D006650:Histocompatibility Testing; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011183:Postoperative Complications; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012307:Risk Factors
D015796:HLA-B27 Antigen; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D008775:Methylprednisolone