Diabetic Complications Associated With New-Onset Diabetes Mellitus in Renal Transplant Recipients

Burroughs, Thomas E.; Swindle, Jason; Takemoto, Steven K.; Lentine, Krista L.; Machnicki, Gerardo; Irish, William; Brennan, Daniel C.; Schnitzler, Mark A.

doi:10.1097/01.tp.0000259617.21741.95

Cited by 131 publications

(77 citation statements)

References 35 publications

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“…It has been reported that Tacrolimus is more diabetogenic than CsA [30,31,32]. In the present work, no significant difference was found between the groups that received Tacrolimus and CsA.…”

Section: Discussioncontrasting

confidence: 40%

Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients

Shehab-Eldin

Shoker

2008

Nephron Clin Pract

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Background: Several groups identified pre-transplant factors which contribute to the development of new onset of diabetes after transplantation (NODAT). Aim: To identify post-transplant risk factors for NODAT. Methods: 55 stable renal transplant patients were divided into group A of 34 recipients with normoglycemia and group B of 21 recipients with impaired fasting glucose. Markers including insulin, pro-insulin, soluble receptors for advanced glycated end products (sRAGE), adiponectin, malondialdehyde, homeostasis model assessment of insulin resistance (HOMA-IR), and β-cell function were calculated at the outset and correlated, thereafter, with the later development of NODAT after a follow-up duration of 14.98 ± 3.97 months. Results: 11.8 and 19% of groups A and B respectively developed NODAT. Insulin, sRAGE, HOMA-IR and basal fasting plasma glucose correlated with the development of NODAT in univariate analysis. A baseline insulin level of 54.54 mU/l predicted the development of NODAT with a specificity of 95.45% and was the only significant factor in the multivariate analysis. β-Cell function was not different among the three groups. Conclusions: A long prodrome of insulin resistance (IR) exists prior to development of NODAT. 50% of patients with NODAT will remit to a normoglycemic state. IR, rather than β-cell dysfunction, precedes the development of NODAT. Serum insulin in stable non-diabetic renal transplant patients can be used as a confirmatory test to the development of future NODAT.

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Section: Discussioncontrasting

confidence: 40%

Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients

Shehab-Eldin

Shoker

2008

Nephron Clin Pract

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“…It is difficult to estimate the actual rate of recurrence of diabetic nephropathy (DN) in renal allografts because about 20% of transplant patients may develop de novo onset of diabetes posttransplantation (PTDM), which can also eventually lead to de novo DN (85). Recurrence of DN accounted for only 1.8% of graft losses in one of the largest series of renal transplants in diabetic recipients (86).…”

Section: Diabetic Nephropathymentioning

confidence: 99%

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Ponticelli¹,

Moroni

Glassock

2011

Clinical Journal of the American Society of Nephrology

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SummaryThe risk of a posttransplant recurrence of secondary glomerulonephritis (GN) is quite variable. Histologic recurrence is frequent in lupus nephritis, but the lesions are rarely severe and usually do not impair the longterm graft outcome. Patients with Henoch-Schonlein nephritis have graft survival similar to that of other renal diseases, although recurrent Henoch-Schonlein nephritis with extensive crescents has a poor prognosis. Amyloid light-chain amyloidosis recurs frequently in renal allografts but it rarely causes graft failure. Amyloidosis secondary to chronic inflammation may also recur, but this is extremely rare in patients with Behcet's disease or in those with familial Mediterranean fever, when the latter are treated with colchicine. Double organ transplantation (liver/kidney; heart/kidney), chemotherapy, and autologous stem cell transplantation may be considered in particular cases of amyloidosis, such as hereditary amyloidosis or multiple myeloma. There is little experience with renal transplantation in light-chain deposition disease, fibrillary/ immunotactoid GN, or mixed cryoglobulinemic nephritis but successful cases have been reported. Diabetic nephropathy often recurs but usually only after many years. Recurrence in patients with small vessel vasculitis is unpredictable but can cause graft failure. However, in spite of recurrence, patient and graft survival rates are similar in patients with small vessel vasculitis compared with those with other renal diseases. Many secondary forms of GN no longer represent a potential contraindication to renal transplantation. The main issues in transplantation of patients with secondary GN are the infectious, cardiovascular, or hepatic complications associated with the original disease or its treatment.

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“…Incident PTDM within the first year after kidney transplantation doubles long-term mortality [3]. Diabetes-associated complications develop at a faster rate in PTDM than in non-transplant patients [4]. Comprehension of the risk factors and dynamics of PTDM is therefore crucial for developing preventive strategies in post-transplant patient care.…”

Section: Introductionmentioning

confidence: 99%

Dynamics of Glucose Metabolism After Kidney Transplantation

Guthoff¹,

Wagner²,

Weichbrodt³

et al. 2017

Kidney Blood Press Res

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Background/Aims: Posttransplantation diabetes mellitus (PTDM) impacts patient and allograft survival after kidney transplantation. Prediabetes, which is an independent risk factor for PTDM, is modifiable also in a post-transplant setting. Understanding the risks and dynamics of impaired glucose metabolism after transplantation is a key component for targeted intervention. Methods: A retrospective chart analysis of all adult non-diabetic renal allograft recipients (n=251, 2007-2014) was performed. Longitudinal follow-up included fasting plasma glucose and HbA1c, as well as data on allograft function and immunosuppression at consecutive time points (months 3-6 to >5 years post transplantation). Results: Throughout follow-up, median prevalence of prediabetes and PTDM was 53.3 [52.4-55.7]% and 15.4 [15.0-16.5]%, respectively. Continuously high fluxes between states of glucose metabolism, with individual patients’ state deteriorating or improving over time, resulted in a high number of incident patients even long after transplantation. The greatest number of patients shifted between normal glucose tolerance and prediabetes, followed by those between prediabetes and PTDM. Conclusion: Prediabetes and PTDM are highly prevalent after kidney transplantation and incidences remain relevant throughout follow-up. Patient fluxes into and out of the prediabetic state show that glucose metabolism is highly dynamic after transplantation. This provides a continuous opportunity for intervention in an aim to reduce diabetes-associated complications.

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Diabetic Complications Associated With New-Onset Diabetes Mellitus in Renal Transplant Recipients

Abstract: NODM is associated with similar complications to those seen in the general population, but these appear to develop at an accelerated rate. Obesity and use of tacrolimus are the only modifiable factors that appear to affect risk of NODM or its complications.

Cited by 131 publications

References 35 publications

Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients

Predictors of New Onset of Diabetes after Transplantation in Stable Renal Recipients

Recurrence of Secondary Glomerular Disease after Renal Transplantation

Dynamics of Glucose Metabolism After Kidney Transplantation

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