Prediabetes in patients receiving tacrolimus in the first year after kidney transplantation: a prospective and multicenter study.
BACKGROUND
Tacrolimus-based immunosuppression, the most widely used regimen in kidney transplantation, increases the risk of new onset diabetes after transplantation (NODAT). However, the prevalence, evolution and risk factors of different prediabetic alterations: impaired fasting glucose, impaired glucose tolerance, and provisional diabetes, have not been established.


METHODS
In this multicenter and prospective study we evaluated 154 nondiabetic kidney transplant recipients receiving tacrolimus, mycophenolate mofetil and low dose steroids. An oral glucose tolerance test was performed 3 and 12 months after transplantation and prediabetes was defined by American Diabetes Association criteria.


RESULTS
Prediabetes was highly prevalent and showed little variation between 3 and 12 months (36% and 33%, respectively). Impaired glucose tolerance was the most frequent abnormality observed (23% and 25%, respectively) observed. In addition, 20% of recipients showed NODAT by 1 year. Multivariate analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.004-1.14), pretransplant body mass index (OR: 1.3, CI: 1.09-1.6) and triglyceride/high density lipoprotein-cholesterol ratio, a marker of insulin resistance, (OR: 1.4, CI: 1.05-1.9) were independent risk factors for prediabetes.


CONCLUSIONS
One in two recipients with tacrolimus-based immunosuppresion showed prediabetes or NODAT by 1 year posttransplantation when properly investigated. Older age and high pretransplant body mass index and triglyceride/high density lipoprotein-cholesterol ratio were risk factors for prediabetes. These findings may help applying early interventions to prevent the disorder.
Porrini
Esteban
E
Hospital Universitario de Canarias, La Laguna, Spain.
Moreno
Jose Manuel
JM
Osuna
Antonio
A
Benitez
Rocio
R
Lampreabe
Ildefonso
I
Diaz
Juan Manuel
JM
Silva
Irene
I
Domínguez
Rosa
R
Gonzalez-Cotorruelo
Julio
J
Bayes
Beatriz
B
Lauzurica
Ricardo
R
Ibernon
Meritxell
M
Moreso
Francisco
F
Delgado
Patricia
P
Torres
Armando
A
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D008076:Cholesterol, HDL / Q000097:blood; D003920:Diabetes Mellitus / Q000139:chemically induced*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects*; D014280:Triglycerides / Q000097:blood
D008076:Cholesterol, HDL; D007166:Immunosuppressive Agents; D014280:Triglycerides; D016559:Tacrolimus