Published online Oct 18, 2021. doi: 10.5500/wjt.v11.i10.432
Peer-review started: June 20, 2021
First decision: July 28, 2021
Revised: August 27, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 18, 2021
Processing time: 115 Days and 13.3 Hours
Solid organ transplantation is a life-saving intervention for end-stage organ disease. Post-transplant diabetes mellitus (PTDM) is a common complication in solid organ transplant recipients, and significantly compromises long-term survival beyond a year.
To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.
Two hundred and six eligible studies identified 75595 patients on Tacrolimus, 51242 on Cyclosporine and 3020 on Sirolimus. Random effects meta-analyses was used to calculate incidence.
Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus (OR = 1.4 95%CI: 1.0–2.0) and sirolimus (OR = 1.8; 95%CI: 1.5–2.2) than with Cyclosporine. The overall incidence of PTDM at years 2-3 was 17% for kidney, 19% for liver and 22% for heart. The risk factors for PTDM most frequently identified in the primary studies were age, body mass index, hepatitis C, and African American descent.
Tacrolimus tends to exhibit higher diabetogenicity in the short-term (2-3 years post-transplant), whereas sirolimus exhibits higher diabetogenicity in the long-term (5-10 years post-transplant). This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.
Core Tip: The aim of this study is to perform a systematic review and meta-analysis to estimate incidence of post-transplant diabetes mellitus (PTDM) and the relative effects of the 3 major immunosuppressants on incidence of PTDM. This study will aid clinicians in recognizing the risk factors for PTDM and careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.