Immunosuppressive medications, clinical and metabolic parameters in new-onset diabetes mellitus after kidney transplantation

Transpl Int. 2008 Jun;21(6):523-30. doi: 10.1111/j.1432-2277.2008.00640.x. Epub 2008 Feb 4.

Abstract

New-onset diabetes after transplantation (NODAT) is a growing concern in transplantation. All modifiable risk factors are not yet identified. We assessed the relationship between baseline clinical and biochemical parameters and NODAT. Eight-hundred and fifty-seven in-Caucasian renal transplant recipients were included. Charts were individually reviewed. The follow-up was 5.3 years (ranges: 0.25-20.8; 5613 patient-years). The incidence of NODAT was 15.0%, 18.4% and 22.0% at 10, 15 and 20 years following transplantation. Age, body mass index (BMI), glucose (all P < 0.0001) and triglycerides [hazard ratio (HR) per 1 mmol/l: 1.44 [1.17-1.77], P = 0.0006] were potent risk factors whereas steroid withdrawal (HR: 0.69 [0.47-1.01], P = 0.0601) reduced the risk. As compared to cyclosporine, sirolimus (HR: 3.26 [1.63-6.49], P = 0.0008) and tacrolimus (HR: 3.04 [2.02-4.59], P < 0.0001) were risk factors for NODAT. The risk of NODAT was comparable for sirolimus (HR: 2.35 [1.06-5.19], P = 0.0350) and tacrolimus (HR: 2.34 [1.46-3.75], P = 0.0004) after adjustments on age, BMI, glucose and steroid withdrawal; however, unlike sirolimus, tacrolimus remained significant after adjustment on triglycerides. The risk of NODAT appeared similar, but its pathophysiology seemed different in sirolimus- and tacrolimus-treated patients; this observation needs confirmation. However, main independent risk factors were age, BMI, initial glucose and triglycerides.

MeSH terms

  • Adult
  • Blood Glucose / metabolism
  • Body Mass Index
  • Cyclosporine / adverse effects
  • Diabetes Mellitus / etiology*
  • Diabetes Mellitus / physiopathology
  • Female
  • Humans
  • Immunosuppressive Agents / adverse effects*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Risk Factors
  • Sirolimus / adverse effects
  • Tacrolimus / adverse effects
  • Triglycerides / blood

Substances

  • Blood Glucose
  • Immunosuppressive Agents
  • Triglycerides
  • Cyclosporine
  • Sirolimus
  • Tacrolimus