Increasing incidence of new-onset diabetes after transplant among pediatric renal transplant patients.
BACKGROUND
Risk of new-onset diabetes after transplant (NODAT) is well characterized for adults but much less understood in pediatric transplant. This study examines the incidence and risk factors of NODAT in pediatric renal transplant patients.


METHODS
The incidence of NODAT over the first 3 years after transplant was examined with the United States Renal Data System data for primary renal transplant recipients (ages 0-21 years, transplanted between 1995 and 2004) with Medicare primary. Patients had no evidence of diabetes before transplant. We estimated the cumulative incidence rate and used Cox proportional hazards regression to identify the risk factors for NODAT. Propensity scores were calculated for immunosuppression choice to adjust for potential confounding factors.


RESULTS
Two thousand one hundred sixty-eight recipients with valid immunosuppression records and without pretransplant evidence of diabetes were included. Unadjusted, cumulative NODAT incidence at 3 years posttransplant was 7.1%. Significant factors for increased risk of NODAT included cytomegalovirus D+/R- serostatus (adjusted hazard ratio [aHR]=1.60), age 13 to 18 years (aHR=2.18), age 19 to 21 years (aHR=2.60), body mass index more than or equal to 30 kg/m (aHR=2.17), and use of tacrolimus (aHR=1.51). We failed to find any significant relationships between NODAT and graft failure or death.


CONCLUSIONS
Although the incidence of NODAT among patients aged 0 to 21 years is lower than that for adult patients, it is higher than suggested by earlier research and may represent an increase over time. The lack of association between NODAT and graft or failure death has important implications for posttransplant care. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.
Burroughs
Thomas E
TE
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, USA. burroute@slu.edu
Swindle
Jason P
JP
Salvalaggio
Paolo R
PR
Lentine
Krista L
KL
Takemoto
Steven K
SK
Bunnapradist
Suphamai
S
Brennan
Daniel C
DC
Schnitzler
Mark A
MA
D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000150:complications; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D007166:Immunosuppressive Agents; D016559:Tacrolimus