Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mTOR inhibitor drugs

Motoo Araki, Stuart M. Flechner, Hazem R. Ismail, Lawrence M. Flechner, Lingmei Zhou, Ithaar H. Derweesh, David Goldfarb, Charles Modlin, Andrew C. Novick, Charles Faiman

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Background. The aim of this study was to evaluate the incidence and risk factors for posttransplant diabetes mellitus (PTDM; defined as new insulin use and/or new hyperglycemia) in 528 kidney recipients using different immunosuppressive agents. Methods. Maintenance therapy included mycophenolate mofetil or azathioprine plus glucocorticoids in combination with Group I cyclosporine (263); Group II tacrolimus (60); or Group III sirolimus (205). Results. The mean follow-up was 39.2 (range 9.0-103.8) months. Overall, the number of patients needing insulin was 7.4% (39/528). The incidences for Groups I, II, and III of 7.6%, 11.7%, and 5.9%, respectively, were not statistically different. Characteristics of patients with PTDM included older age (P=0.007); greater body weight (kg) at transplant, 6 months, and 12 months, respectively (P<0.001); greater BMI (kg/m2) at transplant, 6 months, and 12 months, respectively (P<0.001); more acute rejection episodes 28.2% vs. 13.5% (P=0.012); and increased incidence in African Americans (P=0.03). Multivariable analysis demonstrated increased risk for PTDM (defined as new insulin use) for tacrolimus, (hazard ratio [HR] 3.794, P=0.007); treated rejections (HR 2.491, P=0.0115); age (HR 1.407, P=0.0116); and BMI (HR 1.153, P<0.0001). New insulin use occurred sooner and with less total glucocorticoid dose for tacrolimus patients. If PTDM is defined as all cases of new hyperglycemia, then no immunosuppressive drug group demonstrated an increased risk. Conclusion. The risk for developing PTDM is greatest among older recipients, and those obese at the time of transplant; those given steroid pulse therapy were at exceptionally high-risk. PTDM risk reduction should focus on weight loss in the obese end-stage renal disease population prior to transplant.

Original languageEnglish
Pages (from-to)335-341
Number of pages7
JournalTransplantation
Volume81
Issue number3
DOIs
Publication statusPublished - Feb 1 2006
Externally publishedYes

Keywords

  • Cyclosporine
  • Diabetes
  • Glucocorticoids
  • Immunosuppression
  • Kidney transplantation
  • Mycophenolate mofetil
  • Sirolimus
  • Tacrolimus

ASJC Scopus subject areas

  • Transplantation

Fingerprint Dive into the research topics of 'Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mTOR inhibitor drugs'. Together they form a unique fingerprint.

  • Cite this

    Araki, M., Flechner, S. M., Ismail, H. R., Flechner, L. M., Zhou, L., Derweesh, I. H., Goldfarb, D., Modlin, C., Novick, A. C., & Faiman, C. (2006). Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mTOR inhibitor drugs. Transplantation, 81(3), 335-341. https://doi.org/10.1097/01.tp.0000195770.31960.18