Incidence and relative risk factors in posttransplant diabetes mellitus patients: a retrospective cohort study

Abstract

Background: Posttransplant diabetes mellitus (PTDM) has a long-term impact on kidney transplantation outcomes, such as graft and patient survival. The incidence and risk factors of PTDM are well studied, but long-term follow-up results remain unavailable. We examined the long-term incidence and relative risk factors of PTDM. Methods: A hospital information system database for kidney transplant recipients (KTRs) for a transplantation center between 1983 and 2018 was used to perform this retrospective cohort study. KTRs with DM diagnosis and continuous use of hypoglycemic agents for more than 3 months were defined as having PTDM. Demographics and comorbidities before transplantation were also collected. Kaplan-Meier analyses were used to determine the cumulative incidence and relative risk factors. Results: A total of 296 PTDM cases were confirmed (28.46%) in this study. An increased cumulative incidence associated with age was noted, which was significantly increased in those aged ≥40 years. Male sex, hypertension, hyperlipidemia before transplantation, cytomegalovirus (CMV) infection, and tacrolimus-based regimens were also risk factors. No significant correlation was found between the development of PTDM and the increase of human leukocyte antigen mismatches, the primary causes of end-stage renal disease, and acute rejection. Conclusions: PTDM incidence was high in this cohort study. Characteristics such as age ≥40 years, tacrolimus use, comorbidity of hypertension and hyperlipidemia before transplantation, and CMV infection were associated with a high risk of PTDM. Monitoring and adjusting preventable risk factors such as CMV infection might be useful to prevent PTDM.

An update review of post‐transplant diabetes mellitus: Concept, risk factors, clinical implications and management

“…34 Notably, findings from a Korean cohort study indicate that patients with hypertension face a three-fold increased risk of PTDM. 35 Moreover, certain antihypertensive medications, including beta blockers and thiazide diuretics, have been suggested as potential contributors to the development of T A B L E 1 Known and potential risk factors for the development of post-transplant diabetes mellitus in solid organ transplant recipients. 19…”

Induction of diabetes by Tacrolimus in a phenotypic model of obesity and metabolic syndrome

“…Of them, Tacrolimus (TAC) is the most commonly used immunosuppressant ( 5 ). In obese patients with metabolic syndrome and insulin resistance TAC presents a particularly high diabetogenic effect ( 5 , 6 ). Nowadays, TAC can be considered one of the main causes of PTDM.…”

Discovery of cellular and genetic signatures of immune tolerance in kidney transplant recipients through single cell RNA sequencing analysis

“…2,3 However, long-term use of immunosuppressants has various adverse effects such as infection, metabolic or cardiovascular complications, and de novo development of malignancy after KT. [4][5][6] In addition, the survival of allograft kidney is not permanent even under currently used immunosuppression regimen. Therefore, most kidney transplant recipients (KTRs) would require second transplantation or return to dialysis therapy.…”

“…Clinical outcomes after KT have improved significantly with advances in drugs for the induction and maintenance of immunosuppression and the development of immune‐monitoring methods for sensitization and allograft rejection 2,3 . However, long‐term use of immunosuppressants has various adverse effects such as infection, metabolic or cardiovascular complications, and de novo development of malignancy after KT 4–6 . In addition, the survival of allograft kidney is not permanent even under currently used immunosuppression regimen.…”