Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes?

Transplantation. 1998 Feb 15;65(3):380-4. doi: 10.1097/00007890-199802150-00014.

Abstract

Background: Despite use of lower doses of corticosteroid hormones after renal allotransplantation in the era of cyclosporine and tacrolimus, posttransplant diabetes mellitus remains a common clinical problem.

Methods: We prospectively investigated the effect of posttransplant diabetes on long-term (mean follow-up, 9.3+/-1.5 years) graft and patient survival in the 11.8% of our renal transplant population (n = 40) who developed diabetes after kidney transplantation, and we compared outcome in 38 randomly chosen nondiabetic control patients who had received transplants concurrently.

Results: Twelve-year graft survival in diabetic patients was 48%, compared with 70% in control patients (P = 0.04), and Cox's regression analysis revealed diabetes to be a significant predictor of graft loss (P = 0.04, relative risk = 3.72) independent of age, sex, and race. Renal function at 5 years as assessed by serum creatinine level was inferior in diabetic patients compared to control patients (2.9+/-2.6 vs. 2.0+/-0.07 mg/dl, P = 0.05). Two diabetic patient who experienced graft loss had a clinical course and histological features consistent with diabetic nephropathy; other diabetes-related morbidity in patients with posttransplant diabetes included ketoacidosis, hyperosmolar coma or precoma, and sensorimotor peripheral neuropathy. Patient survival at 12 years was similar in diabetic and control patients (71% vs. 74%).

Conclusions: Posttransplant diabetes mellitus is associated with impaired long-term renal allograft survival and function, complications similar to those in non-transplant-associated diabetes may occur in posttransplant diabetes, and, hence, as in non-transplant-associated diabetes, tight glycemic control may also be warranted in patients with posttransplant diabetes.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Chronic Disease
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / etiology
  • Female
  • Graft Rejection / epidemiology
  • Graft Survival*
  • Humans
  • Kidney Diseases / classification
  • Kidney Diseases / surgery
  • Kidney Transplantation* / mortality
  • Kidney Transplantation* / physiology
  • Male
  • Medical Records
  • Middle Aged
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Survival Analysis
  • Time Factors
  • Treatment Refusal