Endocrine Abstracts

Background and aim: Renal transplantation is considered to be the best renal replacement therapy for patients with end-stage renal disease. Posttransplant complications include NODAT, which is now considered to be determinant of loss of renal allograft, development of infections, and increased risk of morbidity and mortality. Prevalence of NODAT vary, from 2% - 53%.

Materials and methods: We examined the characteristics and risk factors for NODAT in patients with kidney transplants monitored at the Clinical Centre of Montenegro.

Results: Currently 147 patients with kidney transplants are being monitored. Of that number, 13 (8. 84%) have confirmed NODAT. The distribution by gender is 8 men (61. 5%) and 5 women (38. 5%), 8 (61. 5%) patients had obesity. The average age of patients with NODAT at the time of transplantation was 40.6 years. The average time from transplantation to the development of NODAT was 5 years. There were 7 (53. 8%) patients on calcineurin inhibitor (CIN) therapy (tacrolimus) and 6 patients (46. 2%) on ciclosporin therapy. All patients had additional corticosteroid (methylprednisolone), the dose of which was successively reduced after transplantation, while the maintenance dose was 5 mg every second day. There were 13 patients on mycophenolate mofetil (MMF) therapy. Two (15. 4%) patients are being treated with mTOR inhibitor (everolimus) developed breast cancer and were switched from CIN inhibitor to everolimus, both had steroid before transplantation due to the underlying diagnosis (SLE, sarcoidosis). One of the patients had proven BK nephropathy in the follow-up, for which therapy was corrected by reducing the dose of tacrolimus and corticosteroid, but he still developed NODAT. One patient had chronic hepatitis C infection, and developed NODAT after retransplantation with standard doses of immunosuppressants. One patient with primary diagnosis of ADPKD and biopsy-proven FSGS, developed NODAT after a second kidney transplant, another day after rituximab administration due to proven recurrence of FSGS in the transplanted kidney. One patient developed NODAT in the context of proven CMV reactivation after kidney transplantation and it is interesting that he developed an acute myocardial infarction within the same episode of CMV reactivation. NODAT was the earliest to develop after transplantation in patients who had previously received steroid therapy, elderly patients, and patients who had received ciclosporin therapy. All patients were treated with insulin.

Conclusion: The main risk factors for the development of NODAT were obesity, therapy with CIN inhibitors, and long-term use of corticosteroids before and after kidney transplantation.