New onset diabetes after transplantation (NODAT) in renal transplant recipients: a study from tertiary care center in Kashmir, India

Abstract

Background: New onset diabetes after transplantation (NODAT) is a common entity in the post-transplant period after several types of organ transplants like kidney, liver heart and lungs. NODAT is a common complication after solid organ transplantation and has been reported to have an adverse impact on patient and allograft outcomes. Risk stratification and intervention to minimize risk should be an integral part of management of transplant recipients.Methods: A total of 100 patients who underwent renal transplantation were observed for the development of NODAT in the post transplantation period. Patients were evaluated in the pre- transplant and post-transplant period. Risk factors which were associated with the development of NODAT were analyzed.Results: Out of 100 patients, 79 were males and 21 were females. The mean age of the patients undergoing renal transplantation was 40 years. The youngest patient was 18 years old and the eldest was 64 years old. Majority of the patients were in the age group of 31 to 50 years (60 patients, 60%). The incidence of NODAT in present study was 17%. The major risk factors for the development of NODAT were identified as male sex, positive family history of diabetes, history of alcohol intake before renal transplantation, hypertriglyceridemia, post renal transplantation hypomagnesemia, proteinuria, and use of drugs like tacrolimus and prednisolone.Conclusions: NODAT has been identified as a risk factor for graft rejection, long-term graft failure, and decreased patient survival. Once NODAT has been diagnosed, specific anti-hyperglycemic therapy is essential to reach a tight glycemic control, which contributes to significantly reduced post-transplantation morbidity. Due to the importance of NODAT, diabetes education and its impact on the outcome of post-transplantation morbidity and mortality becomes crucial point of research among organ transplantation populations. Diabetes education in a group setting can be adopted for organ transplantation recipients with NODAT.

Assessment of Biochemical Parameters, Kidney Function, and Long-term Outcome in Renal Transplant Recipients

“…Similar observations were reported in populations of Malaysia [33] and Singapore. [38] In Indian studies from Kerala [41] and Kashmir, [42] significance was not found in BMI between NODAT versus non-NODAT groups which is similar to the present study. The previous studies have reported that NODAT is associated with obesity.…”

“…In a study from Kashmir among renal transplant recipients, higher means levels of calcium and lower mean levels of phosphorus have been reported in NODAT subjects than normal individuals. [42] conclusIon The present study revealed that older age (above 40) to be significant factor for the development of NODAT. Higher levels of creatinine, urea, and uric acid in serum might be associated with the development of NODAT and could also be the important markers for the assessment of kidney function in renal transplant recipients.…”

“…We have observed higher frequencies of males than females in the KTRs at our center, though significance in gender was not observed in NODAT as compared to non-NODAT groups, which is similar to the study in Malaysian population. [33] Similarly, different studies among Indian population, that is, from Kerala, [41] Kashmir, [42] Kolkata, [43] and Uttar Pradesh [33] have shown higher percentage of males than females in KTRs and they did not observe statistically sex difference. Kasiske et al [5] and Shah et al [44] have observed males to be at greater risk for NODAT development as compared to females.…”