Reduced incidence of new-onset posttransplantation diabetes mellitus during the last decade.
BACKGROUND
A previous study (1995-1996) of 173 nondiabetic renal transplant recipients (historical cohort; HC) revealed a 20% incidence of new-onset posttransplantation diabetes mellitus (PTDM) and 32% with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG). We examined whether glucose tolerance has improved after recent changes in our immunosuppressive protocol and a switch from deferred to preemptive cytomegalovirus (CMV) therapy.


METHODS
A total of 321 consecutive, nondiabetic patients (new cohort; NC) were examined 10 weeks after kidney transplantation with an oral glucose tolerance test (n=301) between January 2004 and December 2005.


RESULTS
Although recipients in the NC were on average 3 years older [mean (SD): 50.3 (14.6) vs. 47.4 (16.0), P=0.038] and had a higher mean body mass index [24.5 (3.6) vs. 23.5 (3.8) kg/m(2), P=0.003], a significantly lower incidence of both PTDM (13%) and IGT/IFG (18%) was observed in the NC (P<0.001) as compared to the HC. The patients in the NC received a significantly lower mean daily oral prednisolone dose [13.2 (4.7) vs. 15.3 (6.6) mg/day, P<0.001], and had lower frequencies of rejections (36% vs. 57%, P<0.001) and CMV infection (54% vs. 63%, P=0.071). Patients in the NC had significantly lower odds of developing PTDM, even after adjustment for age, prednisolone dose, HLA-B27 status and CMV infection (odds ratio: 0.42, 95% CI: 0.23-0.77, P=0.005).


CONCLUSIONS
The odds of developing PTDM are more than halved over the last decade. Possible explanations are changes in immunosuppressive therapy, fewer rejections, and lower doses of steroids.
Valderhaug
Tone Gretland
TG
Medical Department, Rikshospitalet, University of Oslo, Norway. tone.gretland@netcom.no
Hjelmesaeth
Jøran
J
Rollag
Halvor
H
Leivestad
Torbjørn
T
Røislien
Jo
J
Jenssen
Trond
T
Hartmann
Anders
A
D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000517:prevention & control; D005951:Glucose Tolerance Test; D015796:HLA-B27 Antigen / Q000235:genetics; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008875:Middle Aged; D018579:Patient Selection; D010641:Phenotype; D011183:Postoperative Complications / Q000453:epidemiology*
D015796:HLA-B27 Antigen