I Dedinská1, Ĺ Laca2, M Miklušica1, P Galajda3, M Mokáň3. 1. Surgery Clinic and Transplant Center, University Hospital Martin and Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. 2. Surgery Clinic and Transplant Center, University Hospital Martin and Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic. Electronic address: laca@jfmed.uniba.sk. 3. Clinic of Internal Medicine I, University Hospital Martin and Jessenius Faculty of Medicine, Comenius University, Martin, Slovak Republic.
Abstract
OBJECTIVE: In the case of new-onset diabetes after transplantation (NODAT) development, it is suitable to reduce calcineurin inhibitors and corticosteroids. But change of immunosuppression can be counterproductive and can cause development of rejection and leads to further NODAT aggravation. METHODS: We retrospectively evaluated risk factors after kidney transplantation. Comparison groups were homogeneous in terms of administered immunosuppression, and individual monitored parameters were not distorted by the immunosuppression administered. RESULTS: In the 12-month analysis we identified these risk factors for NODAT: age at the time of transplantation, 50-59 years (P = .0034); age at the time of transplantation, ≥ 60 years (P < .0001); positive family anamnesis for diabetes mellitus type 2 (P < .0001); body mass index at the time of transplantation, ≥ 30 kg/m(2) (P = .0236); prediabetes before transplantation (P < .0009); and proteinuria, >0.15 g/d (P < .0002). In the 5-year analysis, we identified patients who were diagnosed with NODAT after the 1st year. We identified age ≥ 50 years at the time of transplantation to be an independent risk factors for NODAT. CONCLUSIONS: It is advisable to carry out the oral glucose tolerance test even in patients with physiologic levels of fasting glycemia.
OBJECTIVE: In the case of new-onset diabetes after transplantation (NODAT) development, it is suitable to reduce calcineurin inhibitors and corticosteroids. But change of immunosuppression can be counterproductive and can cause development of rejection and leads to further NODAT aggravation. METHODS: We retrospectively evaluated risk factors after kidney transplantation. Comparison groups were homogeneous in terms of administered immunosuppression, and individual monitored parameters were not distorted by the immunosuppression administered. RESULTS: In the 12-month analysis we identified these risk factors for NODAT: age at the time of transplantation, 50-59 years (P = .0034); age at the time of transplantation, ≥ 60 years (P < .0001); positive family anamnesis for diabetes mellitus type 2 (P < .0001); body mass index at the time of transplantation, ≥ 30 kg/m(2) (P = .0236); prediabetes before transplantation (P < .0009); and proteinuria, >0.15 g/d (P < .0002). In the 5-year analysis, we identified patients who were diagnosed with NODAT after the 1st year. We identified age ≥ 50 years at the time of transplantation to be an independent risk factors for NODAT. CONCLUSIONS: It is advisable to carry out the oral glucose tolerance test even in patients with physiologic levels of fasting glycemia.