Journal List > J Korean Soc Transplant > v.23(2) > 1034285

J Korean Soc Transplant. 2009 Sep;23(2):149-153. Korean.
Published online September 30, 2009.  https://doi.org/10.4285/jkstn.2009.23.2.149
Copyright © 2009 The Korean Society for Transplantation
Comparison of New Onset Diabetes according to the Time of Onset in Kidney Transplant Recipients
Kyu Jong Yoon, M.D.,1 Jun Ho Park, M.D.,1 Doo Jin Kim, M.D.,1 Sung Gil Park, M.D.,1 Jeong Hoon Lee, M.D.,1 Joo Seop Kim, M.D.,1 Suk Ja Hyun, R.N.,2 and Samuel Lee, M.D.1
1Department of Surgery, University of Hallym College of Medicine, Seoul, Korea.
2Transplantation Center of Kang-dong Sacred Heart Hospital, Seoul, Korea.

Corresponding author (Email: slee@hallym.or.kr )
Received May 29, 2009; Accepted August 16, 2009.

Abstract

Background

New onset diabetes is a common complication after kidney transplantation. However, the clinical course of post-transplant diabetes mellitus (PTDM) remains unclear. The aim of the present study is to analyze the natural courses and risk factors of PTDM according to the time of onset.

Methods

A total of 216 consecutive kidney transplant recipients were enrolled and patient medical records were investigated retrospectively. PTDM was defined as glucose ≥126mg without previous diabetic history. Patients were classified according to the onset (12 months): early PTDM (E-PTDM) and late PTDM (L-PTDM).

Results

PTDM was observed in 34 (17.4%) patients. The number of E-PTDM and L-PTDM patients was 17 and 17. Compared with normoglycemic patients, the PTDM group was older and showed higher pre-transplant HbA1c level. The use of tacrolimus was associated with the development of E-PTDM (OR=4.87, 1.71~13.8 in 95% CI) but not L-PTDM (OR=0.34, 0.04~2.70 in 95% CI)

Conclusions

The development of E-PTDM and L-PTDM may have different risk factors. It will be important to choose different therapeutic strategy according to the onset of PTDM.

Keywords: Renal transplantation; Post-transplantation diabetes mellitus; Risk factor

Tables


Table 1
Baseline clinical characteristics in Non-PTDM vs. PTDM
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Table 2
Clinical characteristics of different courses of PTDM at 1 year posttranplant
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Table 3
Risk factors associated with overall PTDM development
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Table 4
Risk factors associated with the E-PTDM development
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Table 5
Risk factors associated with L-PTDM development
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References
1. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the united states. Am J Transplant 2003;3:178–185.
2. Davidson J, Wilkinson A, Dantal J, Dotta F, Haller H, Hernandez D, et al. International Expert Panel. New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation 2003;75 10S:3–24.
3. Kang J, Yu SB, Yun IJ, Lee TS, Chung IM, Chung JK, et al. Long-term outcomes of post-transplant diabetes mellitus in renal transplant recipients. J Korean Soc Transplant 2005;19:157–162.
4. Montori VM, Basu A, Erwin PJ, Velosa JA, Gabriel SE, Kudva YC. Posttransplantation diabetes: A systematic review of the literature. Diabetes Care 2002;25:583–592.
5. Kang J, Ha J, Park YJ, Lee T, Jung IM, Chung J, et al. Development and clinical implication of post-transplant diabetes mellitus. J Korean Soc Transplant 2007;21:262–268.
6. Hur KY, Kim MS, Kim YS, Kang ES, Nam JH, Kim SH, et al. Risk factors associated with the onset and progression of posttransplantation diabetes in renal allograft recipients. Diabetes Care 2007;30:609–615.
7. Hjelmesaeth J, Jenssen T, Hartmann A. Diagnosing PTDM. Transplantation 2003;75:1761.
8. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32 S1:S62–S67.
9. Cosio FG, Pesavento TE, Osei K, Henry ML, Ferguson RM. Post-transplant diabetes mellitus: Increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001;59:732–737.
10. Nam JH, Mun JI, Kim SI, Kang SW, Choi KH, Park K, et al. beta-Cell dysfunction rather than insulin resistance is the main contributing factor for the development of postrenal transplantation diabetes mellitus. Transplantation 2001;71:1417–1423.
11. Kang WH, Kim MS, Ju MK, Chang HK, Ahn HJ, Kim SI, et al. Risk factors of post-transplantation diabetes mellitus in renal transplant recipients. J Korean Soc Transplant 2007;21:111–118.
12. Hjelmesaeth J, Hartmann A, Kofstad J, Stenstrøm J, Leivestad T, Egeland T, et al. Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age. Transplantation 1997;64:979–983.
13. Arner P, Gunnarsson R, Blomdahl S, Groth CG. Some characteristics of steroid diabetes: A study in renal-transplant recipients receiving high-dose corticosteroid therapy. Diabetes Care 1983;6:23–25.
14. Parikh CR, Klem P, Wong C, Yalavarthy R, Chan L. Obesity as an independent predictor of posttransplant diabetes mellitus. Transplant Proc 2003;35:2922–2926.
15. Bonato V, Barni R, Cataldo D, Collini A, Ruggieri G, de Bartolomeis C, et al. Analysis of posttransplant diabetes mellitus prevalence in a population of kidney transplant recipients. Transplant Proc 2008;40:1888–1890.
16. Saudek CD, Herman WH, Sacks DB, Bergenstal RM, Edelman D, Davidson MB. A new look at screening and diagnosing diabetes mellitus. J Clin Endocrinol Metab 2008;93:2447–2453.
17. Hoban R, Gielda B, Temkit M, Saha C, Book BK, Baker E, et al. Utility of HbA1c in the detection of subclinical post renal transplant diabetes. Transplantation 2006;81:379–383.
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