Analysis of risk factors and establishment of a risk prediction model for post-transplant diabetes mellitus after kidney transplantation

Development and Validation of a New Score to Assess the Risk of Posttransplantation Diabetes Mellitus in Kidney Transplant Recipients

“…In line with previous publications, 1,19 our study showed that transient posttransplantation hyperglycemia was a strong predictor of PTDM. Posttransplantation hyperglycemia is a common early adverse event after renal transplantation, affecting up to 91% of kidney transplant recipients within the first 48 postoperative h. 38 Notably, despite being thought to be transient in most patients, it reveals that in patients at risk for beta-cell failure in stressful situations, such as the early posttransplant period, high doses of glucocorticoids and calcineurin inhibitors are administered, and the surgery and in-hospital stay may be diabetogenic.…”

“…8 Several studies have shown that PTDM increases risk of severe infections and early cardiovascular complications after transplantation. 1,6,11 PTDM also increases the risk of graft rejection, graft failure, and mortality because of premature cardiovascular diseases. 2,4,7,9,[11][12][13] A retrospective analysis of the United States Renal Data System, which included >11 000 kidney transplant recipients, showed that PTDM is an independent predictor of mortality and graft failure.…”

“…Kidney transplantation is established as the gold-standard therapy of choice for eligible patients with end-stage renal disease with superior patient survival compared with dialysis. 1 However, it is associated with short- and long-term complications. 2,3 Posttransplantation diabetes mellitus (PTDM) is a recognized metabolic complication of solid organ transplantation.…”

“…2 Currently, 2 risk prediction models for PTDM have been developed. 1,17,18 The first model developed by Chakkera et al included variables of the pretransplant period; however, this score did not consider specific risk factors after transplantation, in particular, transient posttransplantation hyperglycemia and the use of tacrolimus, 17 which has been identified as a factor that increases the risk of PTDM 1,19 ; and the second scale included the use of tacrolimus but only during the first 3 mo after kidney transplantation. 1 Our study aimed to explore the clinical risk factors related to PTDM, including not only transient posttransplantation hyperglycemia but also tacrolimus use throughout follow-up, to build a predictive risk model for early detection of kidney transplant recipients at high risk for PTDM.…”

“…In fact, the presence of PTDM itself is associated with cardiovascular outcomes independent of treatment. 16 Therefore, the identification of patients at risk for PTDM might help to guide the implementation of strategies to prevent PTDM, 1,2,8 including lifestyle modifications, early pharmacological treatment, 1 and, potentially, the use of less diabetogenic therapy as an immunosuppressive regimen in low immunologic risk patients. 2 Currently, 2 risk prediction models for PTDM have been developed.…”