Risk factors and consequences of post-transplant diabetes mellitus.
BACKGROUND
The aim of this study is to investigate the clinical course as well as risk factors and prognosis of post-transplant diabetes mellitus (PTDM).


METHODS
Five hundred fifty-five kidney transplant recipients were retrospectively evaluated. PTDM was defined as fasting blood glucose ≥140 mg/dL on at least two consecutive measurements or requirement of oral antidiabetic drug or insulin. Patients with PTDM were divided into subgroups according to time of onset (early; <90 d vs. late, ≥90 d) and duration of diabetes (transient, <90 d vs. sustained ≥90 d).


RESULTS
The frequency of PTDM was 18.3%. In multivariate analysis age (p < 0.001), hepatitis C virus (HCV) infection (p < 0.05) and tacrolimus use (p < 0.001) were independent risk factors. Among 220 HCV+ patients, liver biopsy was performed in 158, the histological grade (3.3 ± 2.8 vs. 4.4 ± 3.1) and stage (0.9 ± 1.1 vs. 1.4 ± 1.2) were significantly more severe in patients with PTDM than in non-diabetics. Incidence of PTDM in patients with severe fibrosis was 46.7%; 19.2% in nil or mild fibrosis (p < 0.05). Patient and graft survival were significantly worse, and cardiovascular events and life-threatening infection episodes were more frequent in PTDM. Half of the patients had early PTDM, while 30.3% of patients with PTDM showed transient nature. Five- and 10-yr death censored graft survival rates were worse in transient subgroup compared with sustained patients with diabetes (log rank 0.025) whereas there was no difference in outcome between early and late subgroups.


CONCLUSIONS
Age, tacrolimus, and HCV are independent risk factors for PTDM. PTDM has a negative impact on both patient and graft survival, irrespective of the time of onset and duration of diabetes.
Demirci
Meltem Sezis
MS
Division of Nephrology, Ege University School of Medicine, Izmir, Turkey. meltem.sezis@ege.edu.tr
Toz
Huseyin
H
Yilmaz
Filiz
F
Ertilav
Muhittin
M
Asci
Gulay
G
Ozkahya
Mehmet
M
Zeytinoglu
Aysin
A
Nart
Deniz
D
Ok
Ercan
E
D000328:Adult; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D016174:Hepacivirus / Q000502:physiology; D006526:Hepatitis C / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use
D007166:Immunosuppressive Agents; D016559:Tacrolimus