Preview

Nephrology (Saint-Petersburg)

Advanced search

NEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION: SINGLE CENTER EXPERIENCE

https://doi.org/10.24884/1561-6274-2017-21-6-20-28

Abstract

New-onset diabetes mellitus  after  transplantation (NODAT) in kidney  transplant recipients promote the development of complications and  have  a negative impact on kidney  transplantation (KT) results.

Aim. Comparison of clinico-demographic characteristics and  KT results in recipients with and  without  NODAT.

Patients and methods.  Study included 439  patients 18+ years without  pre-transplantation diabetes who  underwent KT from  the  deceased donor in our  center from  01.01.2007 to 31.12.2016. All patients after  KT received calcineurin inhibitors and  mycophenolate, 322 received tacrolimus (TAK), 117cyclosporin A (CsA). Seventeen recipients received immunosuppression without  steroids.

Results. NODAT developed in 41 (9.3%) of 439 patients: 33 (10.2%) of 322 on TAK, and  8 of 117 (6.8%) on CsA, p=0.368. The groups with NODAT and  without NODAT did not differ in gender, proportion of patients with polycystic kidney disease, modality and duration of dialysis, features of immunosuppression, although there was  a tendency for older  age and  higher body  mass index  in patients with NODAT. In NODAT group there were significantly more patients with preexisting metabolic syndrome (31.7% versus 12.3%, p = 0.002), post-transplant surgical complications (21.9% vs. 8.5%, p= 0.012), fungal  infections (14.6% vs 5.0%, p=0.026), cardiovascular  complications (26.8% vs. 9.8%, p=0.003), patients who  died  with functioning graft  (17.1% % vs. 5.5%, p = 0.0012). Recipients and  transplants survival was significantly lower in NODAT group (p=0.008, p=0.022, resp.).

Conclusion. NODAT negatively affects the results of KT. Prevention, early detection and adequate treatment of NODAT can reduce the incidence of complications after  KT and  improve recipients and  transplants survival.

About the Authors

E. I. Prokopenko
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

Elena I. Prokopenko - MD PhD, Post-graduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, 495)684-57-91



A. V. Vatazin
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

Prof. Andrey V. Vatazin - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495)684-54-53



E. O. Shcherbakova
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

Evgenia O. Shcherbakova - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495) 684-57-91



R. O. Kantariya
M.F. Vladimirsky Moscow Regional Research Clinical Institute
Russian Federation

Rusudana O. Kantariya - MD PhD, Postgraduate Medical Faculty, Department of transplantology, nephrology and artificial organs.

129110 Moscow, Shchepkin st., 61/2, (495) 684-57-91



References

1. First MR, Dhadda S, Croy R et al. New onset diabetes after transplantation (NODAT): an evaluation of definitions in clinical trials. Transplantation 2013; 96: 58-64. doi: 10.1097/TP.0b013e318293fcf8

2. Lv C, Chen M, Xu M et al. Influencing factors of new-onset diabetes after a renal transplant and their effects on complications and survival rate. PLoS One 2014; 9: e99406. doi: 10.1371/journal.pone.0099406

3. Balla A, Chobanian M. New-onset diabetes after transplantation: a review of recent literature. Curr Opin Organ Transplant 2009; 14: 375-379. doi: 10.1097/MOT.0b013e32832dbb98

4. Palepu S, Prasad GV. New-onset diabetes mellitus after kidney transplantation: Current status and future directions. World J Diabetes 2015; 6(3): 445-455. doi: 10.4239/wjd.v6.i3.445

5. Elmagd MM, Bakr MA, Metwally AH, Wahab AM. Clinicoepidemiologic study of posttransplant diabetes after living donor renal transplant. Exp Clin Transplant 2008; 6: 42-47. pmid: 17400559

6. Kamar N, Mariat C, Delahousse M et al. Diabetes mellitus after kidney transplantation: a French multicentre observational study. Nephrol Dial Transplant 2007; 22: 1986-1993. doi: 10.1093/ndt/gfm011

7. Ahmed IAM, Osman RKH, Khalifa NO et al. New-onset diabetes after transplant in a Sudanese renal transplant population: prevalence and risk factors. Exp Clin Transplant 2017 Jun 28. doi: 10.6002/ect.2016.0198

8. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003; 3: 178-185. doi: 10.1034/j.1600-6143.2003.00010.x

9. Cheungpasitporn W, Thongprayoon C, Vijayvargiya P et al. The risk for new-onset diabetes mellitus after kidney transplantation in patients with autosomal dominant polycystic kidney disease: a systematic review and meta-analysis. Can J Diabetes 2016; 40(6): 521-528. doi: 10.1016/j.jcjd.2016.03.001

10. Chakkera HA, Weil EJ, Swanson CM et al. Pretransplant risk score for new-onset diabetes after kidney transplantation. Diabetes Care 2011; 34: 2141-2145. pmid: 21949218

11. Rodrigo E, Fernández-Fresnedo G, Valero R et al. Newonset diabetes after kidney transplantation: risk factors. J Am Soc Nephrol 2006; 17: S291-S295. doi: 10.1681/ASN.2006080929

12. Impedovo SV, Ditonno P, Ricapito V et al. Advanced age is not an exclusion criterion for kidney transplantation. Transplant Proc 2013; 45: 2650-2653. doi: 10.1016/j.transproceed.2013.08.003

13. Chen Y, Sampaio MS, Yang JW et al. Genetic polymorphisms of the transcription factor NFATc4 and development of new-onset diabetes after transplantation in Hispanic kidney transplant recipients. Transplantation 2012; 93: 325-330. doi: 10.1097/TP.0b013e31823f7f26

14. Nicoletto BB, Souza GC, Fonseca NK et al. Association between 276G/T adiponectin gene polymorphism and new-onset diabetes after kidney transplantation. Transplantation 2013; 96: 1059-1064. doi: 10.1097/TP.0b013e3182a45283

15. Tavira B, Gómez J, Díaz-Corte C et al. Mitochondrial DNA haplogroups and risk of new-onset diabetes among tacrolimustreated renal transplanted patients. Gene 2014; 538: 195-198. doi: 10.1016/j.gene.2014.01.036

16. Sarno G, Muscogiuri G, De Rosa P. New-onset diabetes after kidney transplantation: prevalence, risk factors, and management. Transplantation 2012; 93: 1189-1195. pmid: 22475764

17. Israni AK, Snyder JJ, Skeans MA, Kasiske BL. Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and allograft failure late after kidney transplant. Transpl Int 2012; 25: 748-757. doi: 10.1111/j.1432-2277.2012.01488.x

18. Pereira MJ, Palming J, Rizell M et al. Cyclosporine A and tacrolimus reduce the amount of GLUT4 at the cell surface in human adipocytes: increased endocytosis as a potential mechanism for the diabetogenic effects of immunosuppressive agents. J Clin Endocrinol Metab 2014; 99: E1885-E1894. doi: 10.1210/ jc.2014-1266

19. Gyurus E, Kaposztas Z, Kahan BD. 1. Sirolimus therapy predisposes to new-onset diabetes mellitus after renal transplantation: a long-term analysis of various treatment regimens. Transplant Proc 2011; 43: 1583–1592. doi: 10.1016/j.transproceed.2011.05.001

20. Dedinská I, Laca Ľ, Miklušica J et al. Correlation between CMV infection and posttransplantation new-onset diabetes mellitus. Int J Org Transplant Med 2016; 7 (3): 173-182. pmid: 27721964

21. Okumi M, Unagami K, Hirai T et al. Diabetes mellitus after kidney transplantation in Japanese patients: the Japan academic consortium of kidney transplantation study. Int J Urol 2017; 24(3):197-204. doi: 10.1111/iju.13253

22. Mourad G, Glyda M, Albano L et al. Incidence of posttransplantation diabetes mellitus in de novo kidney transplant recipients receiving prolonged-release tacrolimus-based immunosuppression with 2 different corticosteroid minimization strategies: ADVANCE, a randomized controlled trial. Transplantation 2017; 101(8): 1924-1934. doi: 10.1097/TP.0000000000001453

23. Serrano OK, Kandaswamy R, Gillingham K et al. Rapid discontinuation of prednisone in kidney transplant recipients: 15-year outcomes from the University of Minnesota. Transplantation 2017 Apr 3. doi: 10.1097/TP.0000000000001756 [Epub ahead of print]

24. Cosio FG, Pesavento TE, Kim S et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int 2002; 62: 1440-1446. pmid: 12234317

25. Cole EH, Johnston O, Rose CL, Gill JS. Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival. Clin J Am Soc Nephrol 2008; 3: 814-821. doi: 10.2215/CJN.04681107

26. Cooper L, Oz N, Fishman G et al. New onset diabetes after kidney transplantation is associated with increased mortality – a retrospective cohort study. Diabetes Metab Res Rev 2017 Jul 21. doi: 10.1002/dmrr.2920

27. Lo C, Jun M, Badve SV et al. Glucose-lowering agents for treating pre-existing and new-onset diabetes in kidney transplant recipients. Cochrane Database Syst Rev 2017 Feb 27;2:CD009966. doi: 10.1002/14651858.CD009966.pub2

28. Shivaswamy V, Boerner B, Larsen J. Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes. Endocr Rev 2016; 37(1): 37–61. doi: 10.1210/er.2015-1084

29. Definition, diagnosis, and classification of diabetes mellitus and its complications: report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus (WHO/NCD/ NCS/99.2). Geneva: World Health Organization; 1999

30. Sharif A, Hecking M, de Vries APJ et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant 2014; 14(9): 1992–2000. doi: 10.1111/ajt.12850

31. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. В: Дедов ИИ, Шестакова МВ, Майоров АЮ., ред. Сахарный диабет 2017; 20(1S): 1-112. doi: 10.14341/dm20171s8 [Algoritmy specializirovannoj medicinskoj pomoshhi bol’nym saharnym diabetom / Pod redakciej Dedova II, Shestakovoj MV, Majorova AJu. Saharnyj diabet. 2017; 20(1S): 1-112. doi: 10.14341/dm20171s8]

32. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005; 366: 1059 –1062. doi: 10.1016/S0140-6736(05)67402-8

33. Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome. Circulation 2009; 120: 1640-1645. doi: 10.1161/circulationaha.109.192644

34. Sharif A, Moore R, Baboolal K. Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia. Transplantation 2008; 85: 353–358

35. Weir MR, Fink JC. Risk for post transplant diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis 1999; 34: 1–13. doi: 10.1016/S0272-6386(99)70101-0

36. Pascual J, Galeano C, Royuela A, Zamora J. A systematic review on steroid withdrawal between 3 and 6 months after kidney transplantation. Transplantation 2010; 90(4): 343-349. doi: 10.1097/TP.0b013e3181e58912

37. Hotamisligil GS. Inflammation and metabolic disorders. Nature 2006; 444(7121): 860-867. doi: 10.1038/nature05485

38. Siraj ES, Abacan C, Chinnappa P et al. Risk factors and outcomes associated with posttransplant diabetes mellitus in kidney transplant recipients. Transplant Proc 2010; 42: 1685–1689

39. Wauters RP, Cosio FG, Suarez Fernandez ML et al. Cardiovascular consequences of new-onset hyperglycemia after kidney transplantation. Transplantation 2012; 94: 377–382


Review

For citations:


Prokopenko E.I., Vatazin A.V., Shcherbakova E.O., Kantariya R.O. NEW-ONSET DIABETES MELLITUS AFTER KIDNEY TRANSPLANTATION: SINGLE CENTER EXPERIENCE. Nephrology (Saint-Petersburg). 2017;21(6):20-28. (In Russ.) https://doi.org/10.24884/1561-6274-2017-21-6-20-28

Views: 2251


ISSN 1561-6274 (Print)
ISSN 2541-9439 (Online)