Incidence and risk factors of new onset diabetes after solid organ transplantation: Baskent University experience
Gokturk Kaban1, Ozlem Turhan Iyidir2, Burak Sayin1, Didem Turgut1, Emre Karakaya3, Mehmet A. Haberal3.
1Nephrology, Baskent University, Ankara, Turkey; 2Endocrinology, Baskent University, Ankara, Turkey; 3Transplantation, Baskent University, Ankara, Turkey
Aim: New onset diabetes after transplantation (NODAT) is a common metabolic complication after solid organ transplantation (SOT) which is associated with high morbidity and mortality rates. Recent studies show a wide range of incidence for NODAT. In our study we aimed to determine incidence and risk factors of NODAT after SOT in transplant recipients who were treated in Baskent University Transplant Center.
Materials and Methods: We retrospectively evaluated 500 liver transplant recipients and 1000 kidney transplant recipients who received transplant in Baskent University between 1986 and 2016. Transplant recipients who were meeting the American Diabetes Association 2017 criteria for NODAT (random plasma glucose >200mg/dL; fasting plasma glucose >126mg/dL with fasting defined as no caloric intake for at least 8 hours and plasma glucose >200mg/dL during oral glucose tolerance test) 3 months after SOT were included to our study. Pre-existing diabetes before transplantation was exclusion criteria. All data for immunosuppressive regimen, age, sex, family history, hepatitis, pre-transplant body mass index(BMI), plasma glucose levels, HLA mismatches, acute rejection episodes, cardiovascular diseases, infections and risk factors of diabetes were recorded. Patients were also evaluated for retinopathy, nephropathy and neuropathy.
Results: A total of 44 SOT recipients (4 liver, 40 kidney; 23 male [52.3%] and 21 female [47.7%]) were diagnosed for NODAT in our center. Incidence of NODAT were 2% in liver transplant recipients (LTR) and 4.5% in kidney transplant recipients (KTR). The mean age of NODAT patients was 43.4 ± 9.7 years, median BMI level was 27.3 (20.0-43.2) kg/m². 27 of the patients (61.4%) had a family history of diabetes, 21 of the patients (47.7%) were smokers, 4 patients (9.1%) were HBV positive and 3 patients (6.8%) were HCV positive respectively. Pre-transplant plasma glucose levels (PGL) were 87.1±8.2 mg/dL, HbA1c were 5.7% whereas post-transplant glucose levels were 196.5±23.7 mg/dL, HbA1c were 8.6% respectively. Tacrolimus was the most common immunosuppressive agents among NODAT patients (35 of 44 patients; 79.5%). NODAT patients had higher rates of acute rejection episodes (38.7%) and infection (81.8%) compared to patients who were not diagnosed NODAT (p<0.01). 3 patients(6.8%) with NODAT had retinopathy, 2 (4.5%) had microalbuminuria.
Conclusion: SOT recipients have a high incidence of NODAT and patients who have a family history of DM, smokers, hepatitis positive patients, patients with high BMI levels and patients using tacrolimus are at higher risk for NODAT. Close follow-up, tapering of tacrolimus levels and weight loss and appropriate diet may be preventive for NODAT in SOT recipients.
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