Posttransplant diabetes mellitus and atherosclerotic events in renal transplant recipients: a prospective study.
BACKGROUND
Posttransplant diabetes mellitus (PTDM) is a frequent complication in renal-transplant recipients (RTRs). We conducted a prospective study to assess the potential role of PTDM in the development of atherosclerotic events (AE) in RTRs.


METHODS
Three hundred fifty-seven consecutive RTRs were enrolled in this study. The incidence of various AE were assessed with respect to the presence of PTDM and a number of cardiovascular (CV) risk factors.


RESULTS
The patients were followed for a mean duration of 60+/-14 months. Thirty-nine (11%) patients had PTDM. Fifty AE occurred in 48 (13.4%) patients. Although AE were more frequent in RTRs with PTDM compared with nondiabetic patients (33% vs. 8.8%; P=0.007), PTDM was only modestly associated with AE in the multivariate Cox regression analysis (relative risk [RR] 1.34; 95% confidence interval [CI], 1.04-2.18), mostly caused by significant interactions between PTDM and three confounding variables that were independently associated with AE: age, serum C-reactive protein (CRP) level, and serum high-density lipoprotein cholesterol concentration. Patients with high levels of homocysteine showed a significantly increased risk of AE (RR 4.67; 95% CI 1.82-15.87), as did those with high serum levels of CRP (RR 2.57; 95% CI 1.57-6.23).


CONCLUSIONS
Our study shows a significant association between PTDM and AE. Nevertheless, a large amount of the excess risk of posttransplant diabetic RTR is explained by the coexistence of other CV risk factors. Moreover, high serum levels of CRP and hyperhomocystinemia were found to be among the nontraditional factors contributing to AE in our patients.
Ducloux
Didier
D
Department of Nephrology and Renal Transplantation, Saint-Jacques Hospital, University of Franche-Comté, 25000 Besançon, France. dducloux@chu-besancon.fr
Kazory
Amir
A
Chalopin
Jean-Marc
JM
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000209:etiology*; D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors