title: Day 1 post-operative fasting hyperglycemia may affect graft survival in kidney transplantation.
abstract: BACKGROUND
  Early post-operative hyperglycemia is commonly encountered in patients without pre-existing diabetes mellitus who are undergoing kidney transplantation. The aim of this study was to determine the effect of early post-operative hyperglycemia on graft and patient survival after kidney transplantation in our center.
  
  
  METHODS
  This was a single-center retrospective review of solitary kidney recipients transplanted in our center between January 1998 and December 2007. Of a total of 432 patients, 377 were eligible for the study. Fasting plasma glucose (FPG) levels at day 1 (D1) and day 5 (D5) after transplantation were recorded. Hyperglycemia was defined as FPG ≥ 7.0 mmol/l. Outcome events recorded included deaths and graft failures.
  
  
  RESULTS
  The mean age at transplantation was 43.2 ± 9.5 years and 50.4% were male. The mean FPG levels at D1 and D5 were 7.5 ± 1.3 mmol/L and 5.3 ± 1.3 mmol/L, respectively; 64.2% of recipients had FPG ≥ 7.0 mmol/L on D1 and this was reduced to 8.5% on D5. Recipients with D1 FPG ≥ 7.0 mmol/L had significantly poorer graft survival (39 events) compared to those without D1 hyperglycemia (6 events), with a hazard ratio of 3.708 (95% CI, 1.568-8.766, P=0.003). There was a trend towards better patients survival in recipients with D1 FPG <7.0 mmol/L (P=0.056).
  
  
  CONCLUSIONS
  D1 post-transplantation hyperglycemia may be associated with increased risk of graft failure. It is thus important to closely monitor glucose levels during the early post-transplantation period so that high risk patients can be identified and appropriate measures can be implemented to improve the long-term outcome.
authors.affiliation: Department of Endocrinology, Singapore General Hospital, Singapore. kek.peng.chin@sgh.com.sg
authors.forename: Peng Chin
authors.initials: PC
authors.lastname: Kek
authors.forename: Hong Chang
authors.initials: HC
authors.lastname: Tan
authors.forename: Terence Yi Shern
authors.initials: TY
authors.lastname: Kee
authors.forename: Su-Yen
authors.initials: SY
authors.lastname: Goh
authors.forename: Yong Mong
authors.initials: YM
authors.lastname: Bee
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D005215:Fasting / Q000097:blood; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000209:etiology*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
chemical_list: D001786:Blood Glucose