Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes?
BACKGROUND
Despite use of lower doses of corticosteroid hormones after renal allotransplantation in the era of cyclosporine and tacrolimus, posttransplant diabetes mellitus remains a common clinical problem.


METHODS
We prospectively investigated the effect of posttransplant diabetes on long-term (mean follow-up, 9.3+/-1.5 years) graft and patient survival in the 11.8% of our renal transplant population (n = 40) who developed diabetes after kidney transplantation, and we compared outcome in 38 randomly chosen nondiabetic control patients who had received transplants concurrently.


RESULTS
Twelve-year graft survival in diabetic patients was 48%, compared with 70% in control patients (P = 0.04), and Cox's regression analysis revealed diabetes to be a significant predictor of graft loss (P = 0.04, relative risk = 3.72) independent of age, sex, and race. Renal function at 5 years as assessed by serum creatinine level was inferior in diabetic patients compared to control patients (2.9+/-2.6 vs. 2.0+/-0.07 mg/dl, P = 0.05). Two diabetic patient who experienced graft loss had a clinical course and histological features consistent with diabetic nephropathy; other diabetes-related morbidity in patients with posttransplant diabetes included ketoacidosis, hyperosmolar coma or precoma, and sensorimotor peripheral neuropathy. Patient survival at 12 years was similar in diabetic and control patients (71% vs. 74%).


CONCLUSIONS
Posttransplant diabetes mellitus is associated with impaired long-term renal allograft survival and function, complications similar to those in non-transplant-associated diabetes may occur in posttransplant diabetes, and, hence, as in non-transplant-associated diabetes, tight glycemic control may also be warranted in patients with posttransplant diabetes.
Miles
A M
AM
Department of Medicine, SUNY Health Science Center at Brooklyn, New York 11203, USA.
Sumrani
N
N
Horowitz
R
R
Homel
P
P
Maursky
V
V
Markell
M S
MS
Distant
D A
DA
Hong
J H
JH
Sommer
B G
BG
Friedman
E A
EA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016312:Treatment Refusal