The implications of impaired glucose tolerance after kidney transplantation
Tinney F, Norman S, Naik A, Cibrik D, Sung R, Frietze D, Stegall M, Samaniego M, and Jay C. The implications of impaired glucose tolerance after kidney transplantation. Am J Transplant 2018;18(Suppl 4):543.
Am J Transplant
Background: Post-transplantation diabetes mellitus (PTDM) is highly prevalent after kidney transplantation and associated with significant morbidity. Routine utilization of screening oral glucose tolerance tests (OGTT) after kidney transplant has been scarcely utilized. Given the increased risk of mortality, graft failure, and CV complications associated with PTDM, we sought to describe the prevalence of impaired glucose tolerance (IGT) in a large, single-center cohort of adult nondiabetic kidney transplant patients and to elucidate risk factors and associated long-term outcomes. Methods: A retrospective review of adult living (49.5%) and deceased (50.5%) donor kidney transplant recipients from 2008-2017 was conducted. Individuals with a pretransplant diagnosis of diabetes were excluded. OGTT's were completed within 6 mo post-transplant, at a mean interval of 78 ± 24 days. IGT was defined by 2-hr glucose of 140-199 mg/dL, and PTDM >200 mg/dL. Odds ratio of 95% confidence intervals are reported for risk factors for development of IGT and PTDM. Results: Of 668 recipients, 62% were male, 75% white, 18% black, and 3% Hispanic. 14% underwent prior kidney transplant. Based on screening OGTT, 23.7% of patients developed IGT, with 12% PTDM. Age >50 years was a risk factor for dysglycemia (IGT OR=2.8 (1.9-4.1); PTDM OR=3.1 (1.9-5.1)). BMI >30 kg/m2 at transplant was predictive of IGT (OR=1.7 (1.2-2.5)). Living donation was protective for the development of IGT (OR=0.67 (0.46-0.96)). Race, gender, prior transplant, type of insurance (medicare vs private), cPRA and year of transplant were not predictive for the development of IGT or PTDM. There was no difference in patient or graft survival between recipients with normoglycemia, IGT, or PTDM over a mean follow-up period of 4.2 ± 2.3 years. Conclusions: Over one third of non-diabetic kidney transplant recipients had developed IGT or PTDM within 6 mo post-transplantation. Age >50 and BMI >30 at transplant were associated with increased odds of developing IGT. Recent data from protocol biopsies demonstrates evidence of diabetic nephropathy in prediabetic transplant recipients. Addressing the high incidence of prediabetic states posttransplantation could translate into improved long-term patient and graft outcomes.