BACKGROUND: New-onset diabetes mellitus following renal transplantation is a frequent and serious complication that is associated with poor graft and patient survival. The incidence and clinical correlates of post-transplant diabetes mellitus (PTDM) in the Filipino renal transplant population has not been examined and may vary based on differences in demographics.
OBJECTIVES: To determine the one-year incidence of PTDM and its risk factors, and to compare the acute rejection rate within 6 months of patients who developed PTDM versus those without diabetes mellitus.
STUDY DESIGN: Retrospective cohort
STUDY SETTING: Tertiary, specialty hospital for renal diseases and transplantation
PATIENTS & METHODS: This cohort study included 296 patients who received a kidney transplant from 2002 to 2003. Follow-up was at least 12 months post-transplant. Predisposing factors to PTDM were determined including recipients age, body mass index (BMI), family history of diabetes mellitus, history of gestational diabetes and pre-transplant anti-HCV status; transplant variables such as immunosuppressive regimen, donor source, whether living or cadaver. Fasting blood glucose at months 1, 3, 6 and 12 post-transplant, and serum creatinine at months 6 and 12 were noted. Univariate analysis was performed to test for association and difference between two variables.
RESULTS: The one-year incidence of PTDM among Filipino renal allograft recipients was 15.5 percent. Among the Immunosuppressive treatment groups, 283 (95.6 percent) received cyclosporine; 9 (3 percent) received tacrolimus and only 4 (1.3 percent) received sirolimus. Among patients receiving calcineurin inhibitors, there was a greater trend Of developing PTDM in patients on tacrolimus than in patients given cyclosporine (62.5 percent vs 13.7 percent, p <0.0001), although a firm association was not established because of the small sample size of the tacrolimus group. The following factors were associated with a higher incidence of developing PTDM: BMI>25 (35 percent vs 10.2 percent, OR= 4.75, 95 percent confidence interval 2.25 - 9.92, p<0.001), positive antibodies to HCV (45 percent VS 14.4 percent, OR= 4.96, 95 percent confidence interval 1.13 - 20.35, p=0.005 ), positive family history of DM (39.34 percent VS 9.4 percent, OR= 6.28, 95 percent confidence interval 3.01 - 13.022, p<0.0001) and positive history of Gestational Diabetes (p<0.0001). Acute allograft rejection within the first 6 months post-transplant occurred in 41 percent of those who developed PTDM compared to 23.7 percent of those who did not develop diabetes (p=0.013). Recipients' age (40) and donor kidney source (living vs cadaver) were not found to be significant factors in the development of PTDM.
CONCLUSION: There are many risk factors in the development of PTDM. They should be recognized during the pre-transplant evaluation period so that the complication is recognized early and treated adequately after transplantation. Its development is associated with an increased risk of acute graft rejection.