Doaa M Salah1,2, Mona Hafez3,4, Ftaina I Fadel3,5, Yasmen Ahmed Said Selem6, Noha Musa3,4. 1. Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt. doaasalah@kasralainy.edu.eg. 2. Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt. doaasalah@kasralainy.edu.eg. 3. Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt. 4. Diabetes, Endocrine & Metabolism Pediatric Unit, Cairo University Children Hospital, Cairo, Egypt. 5. Pediatric Nephrology & Transplantation Units, Cairo University Children Hospital, Cairo, Egypt. 6. Ministry of Health, El Sahel Teaching Hospital, Cairo, Egypt.
Abstract
BACKGROUND: Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children. METHODS: Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year. RESULTS: Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0-24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC = - 0.57). CONCLUSIONS: Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Glucose metabolism after kidney transplantation (KT) is highly dynamic with the first post-transplantation year being the most critical period for new-onset diabetes after transplantation (NODAT) occurrence. The present study aimed to analyze dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children. METHODS: Twenty-one consecutive freshly transplanted pediatric kidney transplant recipients (KTRs) were assessed for fasting plasma glucose (FPG) and oral glucose tolerance test (OGTT) weekly for 4 weeks, then every 3 months for 1 year. RESULTS: Interpretation of OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring. Seven patients had NODAT, for which three needed insulin therapy. Hyperglycemia onset was 7.8 ± 13.12 weeks (median (range) = 1 (0-24) week) after KT. Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%, p = 0.029). Patients with abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months (p = 0.03). Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months (p = 0.02, CC = 0.73) and 6 months (p = 0.01, CC = 0.63), and negatively correlating with simultaneous GFR at 9 months (p = 0.04, CC = - 0.57). CONCLUSIONS: Up to two thirds of pediatric KTRs (71.4%) experienced abnormal glycemic state at some point with peak incidence within the first week up to 6 months after KT. OGTT was a better tool for monitoring of glucose metabolism than FPG. Abnormal glycemic state was induced by tacrolimus and adversely affected graft function. A higher resolution version of the Graphical abstract is available as Supplementary information.
Authors: F Vincenti; S Friman; E Scheuermann; L Rostaing; T Jenssen; J M Campistol; K Uchida; M D Pescovitz; P Marchetti; M Tuncer; F Citterio; A Wiecek; S Chadban; M El-Shahawy; K Budde; N Goto Journal: Am J Transplant Date: 2007-03-12 Impact factor: 8.086
Authors: Kirsten A Armstrong; Johannes B Prins; Elaine M Beller; Scott B Campbell; Carmel M Hawley; David W Johnson; Nicole M Isbel Journal: Clin J Am Soc Nephrol Date: 2005-11-02 Impact factor: 8.237