Posttransplant diabetes mellitus in pediatric renal transplant recipients: a report of the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS)

Transplantation. 2001 Sep 27;72(6):1020-4. doi: 10.1097/00007890-200109270-00007.

Abstract

Background: The incidence of renal post transplant diabetes mellitus (PTDM) in adults varies from 3-46%.

Methods: We did a retrospective analysis of 1365 children in The North American Pediatric Renal Transplant Cooperative Study with renal transplant (Tx) reported between January 92 and July 1997. PTDM, defined as >2 weeks of insulin therapy after Tx, developed in 36 patients. A control group of 153/1329 non-PTDM patients was selected and matched for age at Tx and primary diagnosis.

Results: African-Americans were overrepresented (36.1 vs. 17.6%, P=0.017) and Hispanics were underrepresented (5.6 vs. 26.1%, P=0.019) among cases. Although prednisone dose 30 days post-Tx was higher among cases (0.89 mg/kg/day) versus controls (0.71 mg/kg/day), P=0.019, cyclosporine dose was similar. No differences in prednisone or cyclosporine doses were observed at 6, 12, or 24 months post-Tx. Tacrolimus use in PTDM group was high (45%). The estimated incidence of first acute rejection at 1, 3, and 12 months was higher among cases, 0.41+/-0.08, 0.52+/-0.08, 0.61+/-0.08, compared to controls, 0.23+/-0.02, 0.37+/-0.02, and 47+/-0.02 (P=0.058). Crude graft failure rates of 13.5% (5/36) and 12.4% (19/153) were similar between the two groups, so was the calculated creatinine clearance at 12 and 24 months and post-Tx hospitalization days.

Conclusion: PTDM occurs in <3% of children. African-Americans are at higher risk and Hispanics at lower risk for PTDM. Tacrolimus is a significant risk factor for PTDM. Children with PTDM had a higher incidence of acute rejection, but graft survival, kidney function, and hospitalization rates were similar to selected controls.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • African Americans / statistics & numerical data
  • Child
  • Child, Preschool
  • Diabetes Complications
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / ethnology
  • Diabetes Mellitus / etiology*
  • Female
  • Graft Rejection / epidemiology
  • Graft Rejection / etiology
  • Hispanic Americans / statistics & numerical data
  • Humans
  • Immunosuppressive Agents / adverse effects
  • Incidence
  • Kidney Transplantation / adverse effects*
  • Male
  • North America
  • Reference Values
  • Retrospective Studies
  • Risk Factors
  • Tacrolimus / adverse effects

Substances

  • Immunosuppressive Agents
  • Tacrolimus