An observational prospective study to evaluate the outcomes of new onset diabetes after renal transplantation (NODAT) in a tertiary care centre in eastern India

Kumar, Santosh; Sanyal, Debmalya; Das, Pratik; Bhattacharjee, Kingshuk; Rungta, Rohit

doi:10.1016/j.diabres.2019.107948

Cited by 7 publications

(4 citation statements)

References 18 publications

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“…The first successful renal transplant was performed between identical twins in Boston, U.S.A on 23rd of December 1954 [1]. Over the ensuing decades, tremendous improvements had been achieved in the practice and outcomes of renal transplantation, including increased rates of graft and patient survival [2]. Unsurprisingly, transplantation has been a preferred option for treating patients with end-stage renal disease (ESRD) as compared to other treatment modalities [3].…”

Section: Introductionmentioning

confidence: 99%

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

Guad

Taylor‐Robinson

et al. 2020

BMC Nephrol

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Background New-onset diabetes after transplantation (NODAT) is associated with reduced patient and graft survival. This study examined the clinical and selected genetic factors associated with NODAT among renal-transplanted Malaysian patients. Methods This study included 168 non-diabetic patients (58% males, 69% of Chinese ethnicity) who received renal transplantation between 1st January 1994 to 31st December 2014, and were followed up in two major renal transplant centres in Malaysia. Fasting blood glucose levels were used to diagnose NODAT in patients who received renal transplantation within 1 year. Two single nucleotide polymorphisms (SNPs), namely; rs1494558 (interleukin-7 receptor, IL-7R) and rs2232365 (mannose-binding leptin-2, MBL2) were selected and genotyped using Sequenom MassArray platform. Cox proportional hazard regression analyses were used to examine the risk of developing NODAT according to the different demographics and clinical covariates, utilizing four time-points (one-month, three-months, six-months, one-year) post-transplant. Results Seventeen per cent of patients (n = 29, 55% males, 69% Chinese) were found to have developed NODAT within one-year of renal transplantation based on their fasting blood glucose levels. NODAT patients had renal transplantation at an older age compared to non-NODAT (39.3 ± 13.4 vs 33.9 ± 11.8 years, p = 0.03). In multivariate analysis, renal-transplanted patients who received a higher daily dose of cyclosporine (mg) were associated with increased risk of NODAT (Hazard ratio (HR) =1.01 per mg increase in dose, 95% confidence interval (CI) 1.00–1.01, p = 0.002). Other demographic (gender, ethnicities, age at transplant) and clinical factors (primary kidney disease, type of donor, place of transplant, type of calcineurin inhibitors, duration of dialysis pre-transplant, BMI, creatinine levels, and daily doses of tacrolimus and prednisolone) were not found to be significantly associated with risk of NODAT. GA genotype of rs1494558 (HR = 3.15 95% CI 1.26, 7.86) and AG genotype of rs2232365 (HR = 2.57 95% CI 1.07, 6.18) were associated with increased risk of NODAT as compared to AA genotypes. Conclusion The daily dose of cyclosporine and SNPs of IL-7R (rs1494558) and MBL2 (rs2232365) genes are significantly associated with the development of NODAT in the Malaysian renal transplant population.

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Section: Introductionmentioning

confidence: 99%

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

Guad

Taylor‐Robinson

et al. 2020

BMC Nephrol

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“…PTDM portends a worse post-transplant prognosis in SA KTR[ 58 ]. There is no proven benefit to avoiding tacrolimus or prednisone to prevent or control diabetes in any population, so immunological concerns primarily should motivate choice of immunosuppressive medication.…”

Section: Individual Cardiovascular Risk Factorsmentioning

confidence: 99%

Managing cardiovascular disease risk in South Asian kidney transplant recipients

Prasad¹,

Bhamidi²

2021

WJT

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South Asians (SA) are at higher cardiovascular risk than other ethnic groups, and SA kidney transplant recipients (SA KTR) are no exception. SA KTR experience increased major adverse cardiovascular events both early and late post-transplantation. Cardiovascular risk management should therefore begin well before transplantation. SA candidates may require aggressive screening for pre-transplant cardiovascular disease (CVD) due to their ethnicity and comorbidities. Recording SA ethnicity during the pre-transplant evaluation may enable programs to better assess cardiovascular risk, thus allowing for earlier targeted peri- and post-transplant intervention to improve cardiovascular outcomes. Diabetes remains the most prominent post-transplant cardiovascular risk factor in SA KTR. Diabetes also clusters with other metabolic syndrome components including lower high-density lipoprotein cholesterol, higher triglycerides, hypertension, and central obesity in this population. Dyslipidemia, metabolic syndrome, and obesity are all significant CVD risk factors in SA KTR, and contribute to increased insulin resistance. Novel biomarkers such as adiponectin, apolipoprotein B, and lipoprotein (a) may be especially important to study in SA KTR. Focused interventions to improve health behaviors involving diet and exercise may especially benefit SA KTR. However, there are few interventional clinical trials specific to the SA population, and none are specific to SA KTR. In all cases, understanding the nuances of managing SA KTR as a distinct post-transplant group, while still screening for and managing each CVD risk factor individually in all patients may help improve the long-term success of all kidney transplant programs catering to multi-ethnic populations.

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“…4 Immediate postoperative follow-up is important for early identification and thus timely management based on dietary changes; adjustments in the immunosuppression scheme, especially anticalcineurin drug doses; and initiation of drug therapy to achieve glycemic control and avoid long-term microvascular complications. 4,10 The real incidence of NODAT in the pediatric population is unknown. The lack of recent studies on the subject motivated us to conduct this study with the aim of defining the incidence and risk factors for the development of NODAT in pediatric post-kidney transplant patients.…”

Section: Introductionmentioning

confidence: 99%

“…Immediate postoperative follow‐up is important for early identification and thus timely management based on dietary changes; adjustments in the immunosuppression scheme, especially anticalcineurin drug doses; and initiation of drug therapy to achieve glycemic control and avoid long‐term microvascular complications 4,10 …”

Section: Introductionmentioning

confidence: 99%

Changes in blood glucose level after renal transplantation in pediatrics: A study of risk factors of new‐onset diabetes after transplantation

Calani

Valencia

alvarez

et al. 2021

Pediatric Transplantation

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Background New‐onset diabetes after transplantation refers to the development of diabetes after solid organ transplantation without a history of diabetes and is related to poor graft function and lower survival rate. In the kidney transplant population, NODAT occurs in 24% of adults and 9% of children. The real incidence and risk factors in the pediatric population is unknown, which we aimed to determine in this study. Methods A retrospective study was conducted in patients who underwent kidney transplantation in the Pediatric Nephrology Service of the “Federico Gómez” Children's Hospital of Mexico. Results The study included 127 children divided into groups 1 and 2 (without [n = 110 patients, 86.5%] and with NODAT [n = 17 patients, 13.4%], respectively), with median ages of 14 years (interquartile range [IQR], 9–16 years) and 15 years (IQR, 13–16 years; p = .3), respectively. Cox proportional hazards analysis revealed an association between changes from baseline to 24‐h postoperative blood glucose level as a risk factor of the development of NODAT. This implies that each unit increase in blood glucose level in the first hours after transplantation also increases the risk of developing diabetes (95% confidence interval, 1.011–1.021; p = <.001). Conclusions Post‐kidney transplant patients require immediate follow‐up, and attention should be paid to changes in blood glucose level in the first 24 h after transplantation, as any alteration may be an early sign of development of NODAT, especially in patients with a family history of diabetes mellitus.

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An observational prospective study to evaluate the outcomes of new onset diabetes after renal transplantation (NODAT) in a tertiary care centre in eastern India

Cited by 7 publications

References 18 publications

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia

Managing cardiovascular disease risk in South Asian kidney transplant recipients

Changes in blood glucose level after renal transplantation in pediatrics: A study of risk factors of new‐onset diabetes after transplantation

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