Source: Ned Tijdschr Geneeskd  |  Posted 5 years ago

By Charlene Laino

BOSTON, MA -- July 31, 2006 -- Patients who are overweight or who have impaired fasting glucose or positive hepatitis C serology before renal transplantation are at high risk of developing new-onset diabetes mellitus, a multicenter observational study suggests.

Kidney recipients who are administered tacrolimus rather than cyclosporine are also at risk for new-onset diabetes, reported Nassim Kamar, MD, transplant surgeon, Hospital Rangel, Toulouse, France. Dr. Kamar presented the findings here on July 26[^]th[] at the World Transplant Congress (WTC).

The study, which enrolled 527 renal transplant recipients at 17 centers, was designed to identify the risk factors for new-onset diabetes in patients who receive a calcineurin inhibitor after kidney transplantation.

The average age of patients studied was 47.5 years and 61.1% of them were male. Nearly all (95.2%) were Caucasian, and 3.7% had positive hepatitis C serology. Of the total, 261 patients (49.5%) were administered cyclosporine and 266 (50.5%) were given tacrolimus.

Of the total, 7.0% of the patients developed new-onset diabetes mellitus, defined as a fasting plasma glucose of 7 mmol/L or greater or initiation of insulin or oral hypoglycemic therapy. Patients developed diabetes a median of 1.6 months after transplantation.

In univariate analysis, risk factors for new-onset diabetes mellitus were age, impaired fasting glucose (6.1-7 mmol/L) before transplant, 2 or more cardiovascular risk factors, positive hepatitis C serology, body mass index (BMI) > 25 kg/m[^]2[] prior to and at the time of transplant, and tacrolimus therapy.

Patients treated with tacrolimus were more likely to develop diabetes (10.2% vs 3.8%, []P[] = .006). The median time to the development of new-onset diabetes mellitus was 2.9 months in the cyclosporine arm and 0.9 months in the tacrolimus arm ([]P[] = .09).

Surprisingly, patients with a family history of diabetes were not at heightened risk of developing the condition themselves, the researchers reported.

Multivariate analysis showed that patients whose maximal BMI was higher than 25 kg/m[^]2[] before transplantation were 5.1 times more likely to develop new-onset diabetes mellitus than those with lower BMIs (CI 95% 2.0-12.9).

Patients whose fasting glucose levels were 6.1 to 7 mmol/L before transplant, were 4.7 times more likely to develop diabetes than those who did not have impaired fasting glucose levels (CI 95% 1.4-15.3).

Finally, positive hepatitis C serology (OR = 4.7, CI 95% 1.2-17.4) and use of tacrolimus rather than cyclosporine (OR = 3.0, CI 95% 1.4-6.7) also raised the risk of new-onset diabetes mellitus.

Knowing which factors increase a renal transplant's risk of diabetes will allow clinicians to step up preventive efforts in susceptible patients, Dr. Kamar said.

[Presentation title: Incidence and Risk Factors for New Onset Diabetes Mellitus After Renal Transplantation: Results of the Multicentric Observational Study Diapason. Abstract 857]