title: Multivariable risk of developing new onset diabetes after transplant-results from a single-center study of 481 adult, primary kidney transplant recipients.
abstract: BACKGROUND
  Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies.
  
  
  METHODS
  Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre-transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time-dependent covariate) was also tested.
  
  
  RESULTS
  Median follow-up was 57 mo post-transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non-white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one-half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m(2) , non-white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)-the highly elevated NODAT rate observed during the first few months post-transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high-dose (intravenous) corticosteroids.
  
  
  CONCLUSIONS
  The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.
authors.affiliation: Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Gaynor
authors.forename: Gaetano
authors.initials: G
authors.lastname: Ciancio
authors.forename: Giselle
authors.initials: G
authors.lastname: Guerra
authors.forename: Junichiro
authors.initials: J
authors.lastname: Sageshima
authors.forename: Lois
authors.initials: L
authors.lastname: Hanson
authors.forename: David
authors.initials: D
authors.lastname: Roth
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Goldstein
authors.forename: Linda
authors.initials: L
authors.lastname: Chen
authors.forename: Warren
authors.initials: W
authors.lastname: Kupin
authors.forename: Adela
authors.initials: A
authors.lastname: Mattiazzi
authors.forename: Lissett
authors.initials: L
authors.lastname: Tueros
authors.forename: Sandra
authors.initials: S
authors.lastname: Flores
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Barba
authors.forename: Adrian
authors.initials: A
authors.lastname: Lopez
authors.forename: Jose
authors.initials: J
authors.lastname: Rivas
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Vianna
authors.forename: George W
authors.initials: GW
authors.lastname: Burke
mesh_terms: D000328:Adult; D000367:Age Factors; D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery*; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents
keywords: kidney transplantation; multivariable risk factors; new onset diabetes after transplant