title: Risk Factors of Recurrence of Diabetic Nephropathy in Renal Transplants.
abstract: BACKGROUND
  Renal transplantation has been established as the treatment of choice for end-stage renal disease (ESRD) due to diabetic nephropathy. This study aimed to investigate the risk factors for recurrence of diabetic nephropathy (RDN) in renal allografts.
  
  
  METHODS
  We studied 1,011 renal transplant patients from 1986 to 2003, of which 95 had ESRD due to diabetic nephropathy. We retrospectively analyzed the clinical characteristics and outcomes of RDN after renal transplantation.
  
  
  RESULTS
  Of the 95 recipients with ESRD due to diabetic nephropathy, 41 developed RDN and 11 of those 41 underwent graft biopsy. The mean durations from transplantation to RDN and to renal replacement therapy was 81.58 months (range, 54-120 mo), and 109.66 months (range, 27-188.4 mo), respectively. At 5 years, treatment on statins and renin-angiotensin-aldosterone system (RAAS) blockers were associated with a higher survival free from RND (82.2% vs 63.2% [P = .070] and 100% vs 80% vs 0.6% [P = .013], respectively). Compared with cyclosporine, tacrolimus was associated with a higher risk for RND (odds ratio [OR], 4.27; 95% confidence interval [CI], 1.75-5.13; P = .047). High doses of prednisone (>0.06 mg/kg) were also associated with a higher risk of RDN (OR, 3.03; 95% CI, 1.19-8.30; P = .029). The combination of calcineurin inhibitor and mammalian target of rapamycin inhibitor (mTORi) demonstrated the highest risk of RDN (OR, 14.08; 95% CI, 3.72-53.29; P < .01).
  
  
  CONCLUSIONS
  Treatment with tacrolimus and mTORi is the most diabetogenic immunosuppressive regimen. Treatment with tacrolimus entails a greater risk of RDN than with cyclosporine. The administration of statins or RAAS blockers could delay the progression of RDN.
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain. Electronic address: brcubillo@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Rodriguez Cubillo
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Rodriguez
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Calvo
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: V
authors.initials: V
authors.lastname: de la Manzanara
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bautista
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Perez-Flores
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Calvo
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Shabaka
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Delgado
authors.affiliation: Hospital Clinico San Carlos, Madrid, Spain.
authors.forename: A I
authors.initials: AI
authors.lastname: Sanchez-Fructuoso
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects; D001706:Biopsy; D016572:Cyclosporine / Q000009:adverse effects; D003928:Diabetic Nephropathies / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011241:Prednisone; D016559:Tacrolimus