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Yoon, Park, Kim, Park, Lee, Kim, Hyun, and Lee: Comparison of New Onset Diabetes according to the Time of Onset in Kidney Transplant Recipients
Original Article

J Korean Soc Transplant 2009;23(2):149-153.

Published online: 11 September 2009

DOI: https://doi.org/10.4285/jkstn.2009.23.2.149

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, 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

책임저자：이삼열, 서울특별시 강동구 길1동 445 한림대학교 의과대학 외과학교실, 134-010 Tel: 02-2224-2491, Fax: 02-2224-2570 E-mail: slee@hallym.or.kr

Received 29 May 200910 August 2009       Accepted 16 August 2009

Copyright © 2009 The Korean Society for Transplantation

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background:

New onset diabetes is a common complication after kidney transplantation. However, the clinical course of posttransplant 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, Posttransplantation diabetes mellitus, Risk factor

REFERENCES

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Table 1.
Baseline clinical characteristics in Non-PTDM vs. PTDM
  Non-PTDM (n=161) PTDM (n=34) P
Age (years)∗ 46.1±9.0 51.6±8.7 0.001
Month (F/U)∗ 90±51.1 97.5±64.4 NS
Donor age (years)∗ 35.2±12.9 35.9±11.9 NS
Insulin (microIU/mL)∗ 10.4±11.4 9.8±11.5 NS
HbA1c (%)∗ 5.6±0.9 6.3±1.4 0.016
Cholesterol (mmol/L)∗ 186±35.9 181.2±34.8 NS
HLA match (A,B)∗ 1.4±1.0 1.6±0.9 NS
HLA match (DR)∗ 0.9±0.5 0.9±0.4 NS
Postop BP∗ 133.1±14.4 130.1±14.5 NS
Preop BMI (kg/m2)∗ 20.7±2.2 22.3±3.1 0.049
Postop BMI (kg/m2)∗ 21.9±2.4 22.9±3.3 0.049
Sex (M/F)† 94/67 23/11 NS
  (58.4%/41.6%) (67.6%/32.4%)  
IL-2 Ab use† 52 (32.3%) 10 (29.4%) NS
Tacrolimus use† 24 (14.9%) 9 (26.5%) NS
Acute rejection† 40 (24.8%) 9 (26.5%) NS
Donor type (LR/LUR/D)† 71/44/46 14/9/11 NS

∗ Data are n (%);

† Data are means±SD unless otherwise indicated.

Table 2.
Clinical characteristics of different courses of PTDM at 1 year posttranplant
  E-PTDM (n=17) L-PTDM (n=17) P
Age (years)† 49.4±7.8 53.9±9.2 NS
Sex (M/F)∗ 10/7 13/4 NS
  (58.8%/41.2%) (76.5%/23.5%)  
Month (F/U)† 62.1±57.3 133.1±51.1 NS
Donor type (LR/LUR/D) 8/3/6 6/6/5 NS
Acute rejection 5 (29.4%) 4 (23.5%) NS
Tacrolimus use 8 (47.1%) 1 (5.9%) 0.017
IL-2 Ab use 8 (47.1%) 2 (11.2%) NS
HbA1c (＞6) 6 (42.9%) 10 (76.9%) NS
Cholesterol (＞200) 5 (29.4%) 5 (29.4%) NS
HLA match (A,B)     NS
0 2 3  
1 8 0  
2 3 13  
3 3 1  
4 1 0  
HLA match (DR)     NS
0 2 3  
1 14 13  
2 1 1  
Uncontrolled HTN 7 3 NS
BMI change (＞10%) 8 (47.1%) 9 (52.9%) NS

∗ Data are n (%);

† Data are Means±SD unless otherwise indicated.

Table 3.
Risk factors associated with overall PTDM development
Risk factors Odds ratio CI (95%) P
Lower Upper
Recipient age (＞50) 0.989 0.410 2.387 0.980
Tacrolimus use 1.470 0.562 3.850 0.433
HbA1c (＞6) 6.90 2.663 17.877 0.000
BMI change (＞10%) 1.862 0.820 4.224 0.137
Table 4.
Risk factors associated with the E-PTDM development
Risk factors Odds ratio CI (95%) P
Lower Upper
Recipient age (＞50) 1.105 0.340 3.597 0.868
Tacrolimus use 4.143 1.380 12.443 0.011
HbA1c (＞6) 1.548 0.778 11.095 0.112
BMI change (＞10%) 0.044 0.528 4.540 0.426
Table 5.
Risk factors associated with L-PTDM development
Risk factors Odds ratio CI (95%) P
Lower upper
Recipient age (＞50) 0.900 0.257 3.154 0.870
Tacrolimus use 0.150 0.017 1.358 0.092
HbA1c (＞6) 16.035 4.373 58.792 0.000
BMI change (＞10%) 2.103 0.670 6.599 0.203
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