Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jul 15, 2018; 9(7): 132-137
Published online Jul 15, 2018. doi: 10.4239/wjd.v9.i7.132
New-onset diabetes after kidney transplantation: Incidence and associated factors
Vânia Gomes, Florbela Ferreira, José Guerra, Maria João Bugalho
Vânia Gomes, Florbela Ferreira, Maria João Bugalho, Endocrinology, Diabetes and Metabolism Department, Santa Maria Hospital, Lisbon 1649-035, Portugal
José Guerra, Nephrology and Kidney Transplantation Department, Santa Maria Hospital, Lisbon 1649-035, Portugal
Author contributions: Gomes V wrote the manuscript, collected the data and performed the data analysis; Guerra J collected the data; Guerra J, Ferreira F and Bugalho MJ reviewed the manuscript for important intellectual content; all authors participated in designing the study.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Santa Maria Hospital (No. 406/17).
Informed consent statement: Informed consent was not required for study participation or data publication because the clinical data were collected from an institutional database and had been anonymized before analysis.
Conflict-of-interest statement: All authors declare no conflicts-of-interest in relation to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Vânia Gomes, MD, Doctor, Endocrinology, Diabetes and Metabolism Department, Santa Maria Hospital, Avenida Professor Egas Moniz, Lisbon 1649-035, Portugal. vania.rodrigues.gomes@gmail.com
Telephone: +351-912-993251
Received: March 22, 2018
Peer-review started: March 23, 2018
First decision: May 8, 2018
Revised: May 24, 2018
Accepted: June 13, 2018
Article in press: June 13, 2018
Published online: July 15, 2018
Processing time: 114 Days and 14 Hours
Abstract
AIM

To determine the incidence and associated factors of new-onset diabetes after transplantation (NODAT) in a Portuguese central hospital.

METHODS

This single-center retrospective study involved consecutive adult nondiabetic transplant recipients, who had undergone kidney transplantation between January 2012 and March 2016. NODAT was diagnosed according to the criteria of the American Diabetes Association. Data were collected from an institutional database of the Nephrology and Kidney Transplantation Department (Santa Maria Hospital, Lisbon, Portugal) and augmented with data of laboratorial parameters collected from the corresponding patient electronic medical records. Exclusion criteria were preexisting diabetes mellitus, missing information and follow-up period of less than 12 mo. Data on demographic and clinical characteristics as well as anthropometric and laboratorial parameters were also collected. Patients were divided into two groups: With and without NODAT - for statistical comparison.

RESULTS

A total of 156 patients received kidney transplant during the study period, 125 of who were included in our analysis. NODAT was identified in 27.2% of the patients (n = 34; 53% female; mean age: 49.5 ± 10.8 years; median follow-up: 36.4 ± 2.5 mo). The incidence in the first year was 24.8%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation, and 76.5% of the patients developed NODAT in the first 3 mo. In the group that did not develop NODAT (n = 91), 47% were female, with mean age of 46.4 ± 13.5 years and median follow-up of 35.5 ± 1.6 mo. In the NODAT group, the pretransplant fasting plasma glucose (FPG) levels were significantly higher [101 (96.1-105.7) mg/dL vs 92 (91.4-95.8) mg/dL, P = 0.007] and pretransplant impaired fasting glucose (IFG) was significantly more frequent (51.5% vs 27.7%, P = 0.01). Higher pretransplant FPG levels and pretransplant IFG were found to be predictive risk factors for NODAT development [odds ratio (OR): 1.059, P = 0.003; OR: 2.772, P = 0.017, respectively].

CONCLUSION

NODAT incidence was high in our renal transplant recipients, particularly in the first 3 mo posttransplant, and higher pretransplant FPG level and IFG were risk factors.

Keywords: New-onset diabetes after transplant; Incidence; Kidney transplantation; Impaired fasting glucose; Immunosuppression

Core tip: New-onset diabetes mellitus after transplantation (NODAT) is a major complication of kidney transplant. The aim of this study was to evaluate the incidence and associated factors of NODAT among kidney transplant recipients in a single center. A total of 125 patients transplanted at Santa Maria Hospital (Lisbon, Portugal) were assessed, and NODAT was identified in 27.2%. The median time to diagnosis was 3.68 ± 5.7 mo after transplantation and most patients (76.5%) developed NODAT in the first 3 mo posttransplant. Higher pretransplant fasting plasma glucose level and pretransplant impaired fasting glucose were predictive risk factors for NODAT development.