title: Association of metabolic syndrome with development of new-onset diabetes after transplantation.
abstract: 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.
authors: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors: Nathaniel D
authors: ND
authors: Bayer
authors: Philip T
authors: PT
authors: Cochetti
authors: Mysore S
authors: MS
authors: Anil Kumar
authors: Valerie
authors: V
authors: Teal
authors: Yonghong
authors: Y
authors: Huan
authors: Cataldo
authors: C
authors: Doria
authors: Roy D
authors: RD
authors: Bloom
authors: Sylvia E
authors: SE
authors: Rosas
mesh_terms: 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
chemical_list: D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016559:Tacrolimus