Glucose Metabolism Disorders in Renal Transplant Recipients

Abstract

Objective: to assess the frequency of I/D polymorphism of ACE gene and AGT M235T genotype and its impact on glucose metabolism in patients after kidney transplantation. Patients and Methods: Medical records of 53 adult Caucasoid patients covering a period 4th month -4 years after Tx were included in a retrospective analysis. Immunosuppression consisted either of CsA (10 Ps) or Tac (39 Ps) or Rapa (4Ps). All Ps were treated with mycophenolate mofetil or sodium and 10 mg of prednisone. Evaluated groups did not differ in acute rejection episode incidence and methylprednisolon treatment. PCR-RFLP was used to detect gene polymorphisms. Results: Frequencies of ACE gene II: ID: DD genotypes were 34%: 36%: 30% and TT: TM: MM genotypes of AGT 26%: 47%: 27%. Highest fasting glucose level was signifi cantly different in TT homozygous individuals in comparison to MM genotype (mean ± SEM= 8.62 ± 0.78 vs 6.62 ± 0.31 mmol/l, p < 0.05). differences between I/I vs D/D were not statistically signifi cant (8.31 ± 0.65 vs 7.2 ± 0.43 mmol/l, p= 0.15). Highest HbA1c level was signifi cantly different in carriers of at least one T allele in comparison to MM genotype (7.67 ± 0.27 vs 6.94 ± 0.26%, p < 0.05). differences between I/I vs D/D were not signifi cant (7,4 ± 0,2 vs 7,3 ± 0,3%). Conclusions: Our results suggest infl uence of RAS polymorphisms on glucose metabolism after kidney transplantation. Carriage of at least one T allele (M235T) of AGT was linked to increased fasting glycaemia and HbA1c during the follow up. If proven in a larger study, prospective genotyping of RAS on the waiting list could help to further individualization of posttransplant immunosuppressive strategy, with a special regard to metabolic syndrome, e.g. steroid avoidance or minimalization.