title: The combined effect of pre-transplant triglyceride levels and the type of calcineurin inhibitor in predicting the risk of new onset diabetes after renal transplantation.
abstract: BACKGROUND
  Insulin resistance precedes overt diabetes in the general population and hypertriglyceridemia is a reliable marker of the disorder. Thus, patients in the waiting list with hypertriglyceridemia may be at risk for new-onset diabetes after transplantation (NODAT). Objectives. We investigate whether pre-transplant triglyceride (TG) levels are a risk factor for NODAT and whether they exert a combined effect with the type of calcineurin inhibitor (CNI).
  
  
  METHODS
  We analysed 314 consecutive non-diabetic recipients [215 cyclosporine A (CsA); 99 tacrolimus (Tacro)] transplanted between 1999 and 2003 with a mean follow-up of 34 months. Outcome was NODAT defined by ADA criteria.
  
  
  RESULTS
  NODAT developed in 81 recipients (25.8%). Multivariate analysis which included a propensity score for factors determining CNI allocation showed that age (OR: 1.06; 95% CI: 1.03-1.09), pre-transplant BMI (OR: 1.1; 95% CI: 1.02-1.17),TG levels (OR: 1.3 per 50 mg/dl increment, 95% CI: 1.07-1.6) and treated acute rejection (OR: 4.8, 95% CI: 3-11), but not the type of CNI, were independent risk factors for NODAT. A significant interaction between pre-transplant TG and type of CNI was observed. Using CsA as the reference, the combination of Tacro plus pre-transplant hypertriglyceridemia (>/=200 mg/dl) showed an OR of 3.26 (1.4-7.8) to develop NODAT, contrasting with an OR of 0.75 (0.34-1.6) in Tacro recipients with pre-transplant TG levels <200 mg/dl.
  
  
  CONCLUSIONS
  Pre-transplant hypertriglyceridemia was a risk factor for NODAT only in recipients treated with Tacro; it highlights the importance of pre-transplant insulin resistance in the pathogenesis of NODAT.
authors.affiliation: Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320 La Laguna, Tenerife, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: Porrini
authors.forename: Patricia
authors.initials: P
authors.lastname: Delgado
authors.forename: Alejandra
authors.initials: A
authors.lastname: Alvarez
authors.forename: Marian
authors.initials: M
authors.lastname: Cobo
authors.forename: Lourdes
authors.initials: L
authors.lastname: Pérez
authors.forename: José M
authors.initials: JM
authors.lastname: González-Posada
authors.forename: Luis
authors.initials: L
authors.lastname: Hortal
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallego
authors.forename: José J
authors.initials: JJ
authors.lastname: García
authors.forename: Maria
authors.initials: M
authors.lastname: Checa
authors.forename: Adelaida
authors.initials: A
authors.lastname: Morales
authors.forename: Eduardo
authors.initials: E
authors.lastname: Salido
authors.forename: Domingo
authors.initials: D
authors.lastname: Hernández
authors.forename: Armando
authors.initials: A
authors.lastname: Torres
mesh_terms: D015415:Biomarkers / Q000097:blood; D019703:Calcineurin / Q000097:blood; D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000627:therapeutic use*; D006084:Graft Rejection / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015228:Hypertriglyceridemia / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D007333:Insulin Resistance; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D014280:Triglycerides / Q000097:blood*
chemical_list: D015415:Biomarkers; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014280:Triglycerides; D016572:Cyclosporine; D019703:Calcineurin; D016559:Tacrolimus; D008775:Methylprednisolone