title: Characterization of Remitting and Relapsing Hyperglycemia in Post-Renal-Transplant Recipients.
abstract: BACKGROUND
  Hyperglycemia following solid organ transplant is common among patients without pre-existing diabetes mellitus (DM). Post-transplant hyperglycemia can occur once or multiple times, which if continued, causes new-onset diabetes after transplantation (NODAT).
  
  
  OBJECTIVE
  To study if the first and recurrent incidence of hyperglycemia are affected differently by immunosuppressive regimens, demographic and medical-related risk factors, and inpatient hyperglycemic conditions (i.e., an emphasis on the time course of post-transplant complications).
  
  
  METHODS
  We conducted a retrospective analysis of 407 patients who underwent kidney transplantation at Mayo Clinic Arizona. Among these, there were 292 patients with no signs of DM prior to transplant. For this category of patients, we evaluated the impact of (1) immunosuppressive drugs (e.g., tacrolimus, sirolimus, and steroid), (2) demographic and medical-related risk factors, and (3) inpatient hyperglycemic conditions on the first and recurrent incidence of hyperglycemia in one year post-transplant. We employed two versions of Cox regression analyses: (1) a time-dependent model to analyze the recurrent cases of hyperglycemia and (2) a time-independent model to analyze the first incidence of hyperglycemia.
  
  
  RESULTS
  Age (P = 0.018), HDL cholesterol (P = 0.010), and the average trough level of tacrolimus (P<0.0001) are significant risk factors associated with the first incidence of hyperglycemia, while age (P<0.0001), non-White race (P = 0.002), BMI (P = 0.002), HDL cholesterol (P = 0.003), uric acid (P = 0.012), and using steroid (P = 0.007) are the significant risk factors for the recurrent cases of hyperglycemia.
  
  
  CONCLUSIONS
  This study draws attention to the importance of analyzing the risk factors associated with a disease (specially a chronic one) with respect to both its first and recurrent incidence, as well as carefully differentiating these two perspectives: a fact that is currently overlooked in the literature.
authors.affiliation: Department of Industrial Engineering, School of Computing, Informatics and Decision Systems Engineering, Arizona State University, Tempe, Arizona, United States of America.
authors.forename: Alireza
authors.initials: A
authors.lastname: Boloori
authors.affiliation: Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, United States of America.
authors.forename: Soroush
authors.initials: S
authors.lastname: Saghafian
authors.affiliation: Division of Nephrology and Transplantation, Mayo Clinic School of Medicine, Scottsdale, Arizona, United States of America.
authors.forename: Harini A
authors.initials: HA
authors.lastname: Chakkera
authors.affiliation: Division of Endocrinology, Mayo Clinic School of Medicine, Scottsdale, Arizona, United States of America.
authors.forename: Curtiss B
authors.initials: CB
authors.lastname: Cook
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D020123:Sirolimus / Q000627:therapeutic use; D013256:Steroids / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D066027:Transplant Recipients
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids; D020123:Sirolimus; D016559:Tacrolimus