Pre-transplantation glucose testing for predicting new-onset diabetes mellitus after renal transplantation.
OBJECTIVE
New-onset diabetes after renal transplantation (NODAT) adversely affects graft and patient survival. However, NODAT risk based on pre-transplant blood glucose (BG) levels has not been defined. Our goal was to identify the best pre-transplant testing method and cut-off values.


METHODS
We performed a case-control analysis of non-diabetic recipients who received a live donor allograft with at least 6 months post-transplant survival. Pre-transplant glucose abnormalities were excluded through 75 g oral glucose tolerance testing (OGTT) and random BG (RBG) measurement. NODAT was defined based on 2003 Canadian Diabetes Association criteria. Multivariate logistic and Cox regression analysis was performed to determine independent predictor variables for NODAT. Receiver-operating-characteristic (ROC) curves were constructed to determine threshold BG values for diabetes risk.


RESULTS
151 recipients met initial entry criteria. 12 had pre-transplant impaired fasting glucose and/or impaired glucose tolerance, among who 7 (58%) developed NODAT. In the remaining 139, 24 (17%) developed NODAT. NODAT risk exceeded 25% for those with pre-transplant RBG > 6.0 mmol/l and 50% if > 7.2 mmol/l. Pre-transplant RBG provided the highest AUC (0.69, p = 0.002) by ROC analysis. Increasing age (p = 0.025), acute rejection (p = 0.011), and RBG > 6.0 mmol/l (p = 0.001) were independent predictors of NODAT.


CONCLUSIONS
Pre-transplant glucose testing is a specific marker for NODAT. Patients can be counseled of their incremental risk even within the normal BG range if the OGTT is normal.
Ramesh Prasad
G V
GV
Division of Nephrology, University of Toronto, Toronto, ON, Canada. prasadr@smh.toronto.on.ca
Huang
M
M
Bandukwala
F
F
Nash
M M
MM
Rapi
L
L
Montada-Atin
T
T
Meliton
G
G
Zaltzman
J S
JS
D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity