Endocrine Abstracts

Diabetes mellitus (DM) is one of the most serious comorbidities in kidney transplant recipients. New onset diabetes after kidney transplantation (NODAT) is a common and an important complication following solid organ transplantation. It is associated with poor graft function and increased cardiovascular complications. Therefore, management of hyperglycemia after transplantation is important to reduce diabetes-related risks. We aimed to compare the effects of pre-existing DM and NODAT on graft functions in kidney transplant recipients.

Methods: Fifty-nine kidney transplant recipients were divided into two groups: pre-existing diabetics (n=28, 52.7±10.2 years, 12 males) and NODAT (n=31, 49.9±11.8 years, 18 males). HbA1c and renal functions at the first year of transplantation and the last visit were obtained.

Results: The median post-transplant follow-up durations were 62.5 months in pre-existing DM group and 65 months in NODAT group. The median diagnosis time in NODAT group was 2.5 months (range: 1–159) after transplantation and thirteen recipients were diagnosed at the first month. There was no significant difference between gender, age, donor age, donor type and body mass index values in NODAT and pre-existing diabetics groups. Tacrolimus based immunosuppressive regimen ratios were significantly higher in NODAT group (61.3% vs. 29%, P=0.007). HbA1c levels (6.9±2 vs. 7.8±1.6%, P=0.036) at first year of transplantation were lower in NODAT group. HbA1c levels of both groups at the last visit were similar (7.49±1.7% in NODAT and 7.79±1.3% in pre-existing diabetics). Serum creatinine levels at the first year of transplantation (1.29±0.75 vs. 1.48±0.53 mg/dL) and at the last visit (1.67±1.58 vs. 2.14±1.63 mg/dL) were comparable in NODAT and pre-existing diabetics groups, respectively (P=0.056). Estimated glomerular filtration rate values at the first year of transplantation (69.5±27.2 vs. 56.0±29.7 mL/min/1.73 m², P=0.021) and at the last visit (61.0±27.7 vs. 42.7±21.2 mL/min/1.73 m², P=0.007) in NODAT group were significantly higher than those of pre-existing diabetics group. The ratio of graft lost in NODAT group was lower than that of the pre-existing diabetes group (6.5% vs. 14.3%, P=0.311).

Conclusion: Although glycemic control was achieved in both groups in our study, the presence of pre-existing diabetes was a risk factor for graft failure after kidney transplantation. Therefore, longer diabetes duration could negatively affect graft function in recipients with pre-existing diabetes.