New-onset diabetes mellitus after renal transplantation.
BACKGROUND
New-onset diabetes mellitus after organ transplantation (PTDM) significantly impairs patient and organ survival. Published rates of PTDM range from 2% to 54%, depending on the definition.


OBJECTIVE
To analyze incidence of PTDM after renal transplantation according to recent guidelines and to evaluate implementation of a prospective standardized screening protocol.


METHODS
Data for all consecutive patients who underwent transplantation from 2000 to 2006 were analyzed retrospectively for PTDM. In a prospective pilot trial all candidates for living related donor transplantation underwent a 75-g oral glucose tolerance test at evaluation prior to renal transplantation and at 3, 6, and 12 months thereafter.


RESULTS
Data for 181 out of 271 consecutive patients were analyzed. Of these patients, 36 (19.9%) developed PTDM. Age, body mass index, pretransplantation fasting glucose concentration, and number of HLA mismatches were significant predictive risk factors. Posttransplantation diabetes mellitus occurred more frequently in patients receiving a cadaver organ compared with a living donor organ and in those receiving tacrolimus therapy vs cyclosporine therapy. Preliminary results demonstrated a 55.5% incidence of PTDM at 3 months in patients who received a living donor organ, much higher than expected.


CONCLUSIONS
With an incidence of approximately 20%, PTDM is a frequent complication of transplantation. Prospective screening using oral glucose tolerance testing is a more sensitive method for detection of impaired glucose metabolism and PTDM. Relevance and therapeutic consequences must be determined in large-scale prospective studies.
Eckhard
M
M
3rd Med Dept, University Hospital Giessen and Marburg, Giessen, Germany. michael.eckhard@innere.med.uni-giessen.de
Schindler
R A
RA
Renner
F C
FC
Schief
W
W
Padberg
W
W
Weimer
R
R
Bretzel
R G
RG
Brendel
M D
MD
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002102:Cadaver; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005951:Glucose Tolerance Test; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014019:Tissue Donors; D055815:Young Adult
D001786:Blood Glucose; D006680:HLA Antigens