Risk factors and outcomes associated with posttransplant diabetes mellitus in kidney transplant recipients.
BACKGROUND
Although our understanding of the risk factors involved in the occurrence of posttransplant diabetes mellitus (PTDM) as well as its outcomes has improved, it still remains incomplete. Our study attempts to analyze the risk factors as well as the outcomes associated with PTDM in the renal transplant patients at the Cleveland Clinic.


METHODS
Our study is a retrospective, case-control study. We screened 209 charts of 217 patients who received single-organ kidney transplant at the Cleveland Clinic between January 1996 and December 1998. PTDM was defined by the American Diabetes Association criteria of either a fasting blood glucose >or=126 mg/dL or random blood sugars >or=200 mg/dL confirmed on a second occasion. Kidney transplant recipients who developed PTDM (cases) were compared with kidney transplant recipients who did not develop diabetes but were matched for the time of transplant (controls).


RESULTS
Forty-nine patients (23%) developed PTDM. The data of 47 cases and 47 controls were analyzed. Age >or=40 years, body mass index >or=30, pretransplant triglyceride levels >150 mg/dL, and presence of graft rejection were significant risk factors for developing PTDM. Smoking was associated with increased risk of PTDM but failed to achieve statistical significance. Compared with controls, PTDM patients had higher risk of cardiovascular disease, infections, and graft rejection.


CONCLUSIONS
Our results show that PTDM is a significant problem after kidney transplantation, and those who have high risk should be closely monitored after transplant and aggressively treated if they develop diabetes to minimize the risk of complications.
Siraj
E S
ES
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA. esiraj@temple.edu
Abacan
C
C
Chinnappa
P
P
Wojtowicz
J
J
Braun
W
W
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D016022:Case-Control Studies; D001026:Coronary Artery Bypass; D003404:Creatinine / Q000097:blood; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006084:Graft Rejection / Q000453:epidemiology; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011507:Proteinuria / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D014280:Triglycerides; D003404:Creatinine