Association of metabolic syndrome with development of new-onset diabetes after transplantation.
BACKGROUND
New-onset diabetes after transplantation (NODAT) is a major posttransplant complication associated with lower allograft and recipient survival. Our objective was to determine whether metabolic syndrome pretransplant is independently associated with NODAT development.


METHODS
We recruited 640 consecutive incident nondiabetic renal transplant recipients from three academic centers between 1999 and 2004. NODAT was defined as the use of hypoglycemic medication, a random plasma glucose level more than 200 mg/dL, or two fasting glucose levels more than or equal to 126 mg/dL beyond 30 days posttransplant.


RESULTS
Metabolic syndrome was common pretransplant (57.2%). NODAT developed in 31.4% of recipients 1 year posttransplant. Participants with metabolic syndrome were more likely to develop NODAT compared with recipients without metabolic syndrome (34.4% vs. 27.4%, P=0.057). Recipients with increasing number of positive metabolic syndrome components were more likely to develop NODAT (metabolic syndrome score prevalence at 1 year: 0 components-0.0%, 1-24.2%, 2-29.3%, 3-31.0%, 4-34.8%, and 5-73.7%, P=0.001). After adjustment for demographics, age by decade (hazard ratio [HR] 1.34 [1.20-1.50], P<0.0001), African American race (HR 1.35 [1.01-1.82], P=0.043), cumulative prednisone dosage (HR 1.18 [1.07-1.30], P=0.001), and metabolic syndrome (HR 1.34 [1.00-1.79], P=0.047) were independent predictors of development of NODAT at 1 year posttransplant. In a multivariable analysis incorporating the individual metabolic syndrome components themselves as covariates, the only pretransplant metabolic syndrome component to remain an independent predictor of NODAT was low high-density lipoprotein (hazard ratio [HR] 1.37 [1.01-1.85], P=0.042).


CONCLUSIONS
Metabolic syndrome is an independent predictor for NODAT and is a possible target for intervention to prevent NODAT. Future studies to evaluate whether modification of metabolic syndrome factors pretransplant reduces NODAT development are needed.
Bayer
Nathaniel D
ND
Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Cochetti
Philip T
PT
Anil Kumar
Mysore S
MS
Teal
Valerie
V
Huan
Yonghong
Y
Doria
Cataldo
C
Bloom
Roy D
RD
Rosas
Sylvia E
SE
D001786:Blood Glucose / Q000378:metabolism; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology*; D005215:Fasting; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology; D008297:Male; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D007690:Polycystic Kidney Diseases / Q000453:epidemiology; D015995:Prevalence; D012044:Regression Analysis; D016559:Tacrolimus / Q000627:therapeutic use
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016559:Tacrolimus