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.
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.
Porrini
Esteban
E
Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320 La Laguna, Tenerife, Spain.
Delgado
Patricia
P
Alvarez
Alejandra
A
Cobo
Marian
M
Pérez
Lourdes
L
González-Posada
José M
JM
Hortal
Luis
L
Gallego
Roberto
R
García
José J
JJ
Checa
Maria
M
Morales
Adelaida
A
Salido
Eduardo
E
Hernández
Domingo
D
Torres
Armando
A
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*
D015415:Biomarkers; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014280:Triglycerides; D016572:Cyclosporine; D019703:Calcineurin; D016559:Tacrolimus; D008775:Methylprednisolone