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NDT Advance Access originally published online on November 19, 2007
Nephrology Dialysis Transplantation 2008 23(4):1436-1441; doi:10.1093/ndt/gfm762
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© The Author [2007]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The combined effect of pre-transplant triglyceride levels and the type of calcineurin inhibitor in predicting the risk of new onset diabetes after renal transplantation

Esteban Porrini1, Patricia Delgado1, Alejandra Alvarez1, Marian Cobo1, Lourdes Pérez1, José M. González-Posada1, Luis Hortal2, Roberto Gallego2, José J. García3, Maria Checa4, Adelaida Morales5, Eduardo Salido1,6,7, Domingo Hernández1 and Armando Torres1,6,7

1 Nephrology Section and Research Unit, Hospital Universitario de Canarias, Spain 2 Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Spain 3 Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain 4 Hospital Insular, Las Palmas de Gran Canaria, Spain 5 Hospital General de Lanzarote, Puerto del Rosario, Lanzarote, Spain 6 Instituto de Investigación Nefrológica Reina, Sofía, Spain 7 University of La Laguna, La Laguna, Spain

Armando Torres, Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320 La Laguna, Tenerife, Spain. Tel: +34-922678380; Email: atorres{at}ull.es



  Abstract

Background. Insulin resistance precedes overt diabetes in the general population and hypertriglyceridemia is a reliable marker of the disorder. Thus, patients in the waiting list with hypertriglyceridemia may be at risk for new-onset diabetes after transplantation (NODAT).

Objectives. We investigate whether pre-transplant triglyceride (TG) levels are a risk factor for NODAT and whether they exert a combined effect with the type of calcineurin inhibitor (CNI).

Methods. We analysed 314 consecutive non-diabetic recipients [215 cyclosporine A (CsA); 99 tacrolimus (Tacro)] transplanted between 1999 and 2003 with a mean follow-up of 34 months. Outcome was NODAT defined by ADA criteria.

Results. NODAT developed in 81 recipients (25.8%). Multivariate analysis which included a propensity score for factors determining CNI allocation showed that age (OR: 1.06; 95% CI: 1.03–1.09), pre-transplant BMI (OR: 1.1; 95% CI: 1.02–1.17),TG levels (OR: 1.3 per 50 mg/dl increment, 95% CI: 1.07–1.6) and treated acute rejection (OR: 4.8, 95% CI: 3–11), but not the type of CNI, were independent risk factors for NODAT. A significant interaction between pre-transplant TG and type of CNI was observed. Using CsA as the reference, the combination of Tacro plus pre-transplant hypertriglyceridemia (≥200 mg/dl) showed an OR of 3.26 (1.4–7.8) to develop NODAT, contrasting with an OR of 0.75 (0.34–1.6) in Tacro recipients with pre-transplant TG levels <200 mg/dl.

Conclusion. Pre-transplant hypertriglyceridemia was a risk factor for NODAT only in recipients treated with Tacro; it highlights the importance of pre-transplant insulin resistance in the pathogenesis of NODAT.

Keywords: insulin resistance; NODAT; tacrolimus

Received for publication: 22. 5.07
Accepted in revised form: 20. 9.07


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