Background: Posttransplant diabetes mellitus (PTDM) is a common complication of renal transplantation. We evaluated risk factors for PTDM.
Patients and methods: This retrospective evaluation of 1112 patients transplanted from January 2001 to July 2007 was performed based on PTDM diagnosis using The American Diabetes Association criteria. After informed consent, The Ahmedabad Tolerance induction protocol (ATIP) was carried out in 846 of 988 living-related donor (LRD) cases versus 266 who underwent grafting under conventional immunosuppression (controls).
Results: PTDM was observed in 6.6% ATIP and 19.1% controls. Mean body mass index increased by 5.2% posttransplant among PTDM versus 1.2% in non-PTDM patients. There were 14.2% hepatitis C virus (HCV)-positive patients treated with ATIP, 27.5% among the controls; 8.3% of ATIP patients developed PTDM versus 15.4% of controls. Mean PTDM age was 43.6 years versus 41.4 years in the non-PTDM group. In ATIP, 20% HCV-positive patients were on tacrolimus versus 33.3% of controls. Antirejection therapy was necessary in 5.3% ATIP, 31.6% controls with 20% of both cohorts developing PTDM. For PTDM control, none of the ATIP subjects required insulin but 39.3%, oral hypoglycemic agents (OHA) and 60.7% diet versus 22.2% of controls on insulin, 37% OHA, and 40.7% diet control. ATIP showed higher chances of PTDM in the early posttransplant period versus delayed-onset in the controls. Calcineurin inhibitors increased PTDM risk. Mean serum creatinine in PTDM was comparable in all groups. HCV positivity increased PTDM risk with 20% to 33% cumulative effect of bolus steroid and tacrolimus therapy.
Conclusion: Risk factors for PTDM were higher HCV positivity, BMI, and use of tacrolimus, cyclosporine or pulse steroids. ATIP seemed to be safer than the controls.