Monitoring of blood glucose after pediatric kidney transplantation: a longitudinal cohort study

Abstract

Background Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children. Methods Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year. Results Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0–24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC = − 0.57). Conclusions Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information.

A dual-purpose sensor with a sawtooth U-shaped cavity and a rectangle-shaped cavity in a MIM waveguide structure

“…During the process, electron beam vaporizes and coats the carrier with the silver layer before removing the resin marks. Finally, the cavity is formed during the lifting process [59][60][61].…”

Multidrug resistant 1 (MDR1) C3435T and G2677T gene polymorphism: impact on the risk of acute rejection in pediatric kidney transplant recipients

“…As regard the centre policy for treatment of AR, all cases started treatment with 3 IV pulses of methylprednisolone (150–250 mg/m2/dose), initiated even prior to graft biopsy and followed by rapid tapering of oral steroids to or just above the maintenance dose. Further treatment of AR was determined according to the pathological findings in allograft biopsy: a) Anti-thymocyte globulin (ATG) was given in all steroid resistant acute TCMR that was defined as no response within 5–7 days after the first dose .b) options for acute ABMR included plasma exchange (PEX), intra venous immunoglobulins (IVIG) and anti-CD20 monoclonal antibody (rituximab) [ 27 ].…”