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NDT Advance Access originally published online on January 3, 2008
Nephrology Dialysis Transplantation 2008 23(6):2033-2042; doi:10.1093/ndt/gfm875
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


Early clinical assessment of glucose metabolism in renal allograft recipients: diagnosis and prediction of post-transplant diabetes mellitus (PTDM)

Dirk R. J. Kuypers, Kathleen Claes, Bert Bammens, Pieter Evenepoel and Yves Vanrenterghem

Department of Nephrology and Renal Transplantation, University Hospitals Leuven, University of Leuven, Belgium

Correspondence and offprint requests to: Dirk R. J. Kuypers, Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, B-3000 Leuven, Belgium. Tel: +32-16-344580; Fax: +32-16-344599; E-mail: Dirk.kuypers{at}uz.kuleuven.ac.be



  Abstract

Background. Post-transplant diabetes mellitus (PTDM) has serious consequences for renal allograft survival, cardiovascular risk and patient survival.

Methods. The predictive value of a fasting plasma glucose (FPG) level and oral glucose tolerance test (OGTT) on the fifth day post-transplantation were prospectively evaluated in 359 de novo renal allograft recipients. PTDM was defined as the uninterrupted need for glucose-lowering medication for at least 3 months.

Results. Sixty-four patients (17.8%) developed PTDM (follow-up 42.8 ± 16.9 months). Recipient age, body mass index (BMI), biopsy-proven acute rejection (BPAR), early graft function and proteinuria, tacrolimus-based therapy, cumulative corticosteroid dose and thiazide diuretics were associated with PTDM (univariate analysis). Multivariate logistic regression analysis identified age [OR (odds ratio): 1.05 (95% confidence interval: 1.019–1.083)], BMI [OR: 1.09 (1.013–1.189)], proteinuria on Day 5 [OR: 1.51 (1.043–2.210)] and BPAR [OR: 2.74 (1.345–5.604)] as independent risk factors for PTDM while a normal OGTT on Day 5 post-transplantation was associated with a strongly reduced risk for PTDM [OR: 0.03 (0.008–0.166)]. A similar risk reduction was conferred by a normal FPG on Day 5 [OR: 0.06 (0.012–0.338)]. OGTT had the best sensitivity (93.4%) and specificity (71.9%) with a high negative predictive value (97.6%).

Conclusion. The Day 5 OGTT is an independent predictor of PTDM that can be used for identifying recipients at reduced risk for PTDM, taking into account the impact of independent clinical risk factors like age, BMI and BPAR (treatment). This information can help clinicians in directing therapeutic management of modifiable risk factors for PTDM after renal transplantation.

Keywords: immunosuppressive drugs; new onset diabetes mellitus after transplantation (NODAT); oral glucose tolerance test (OGTT); post-transplant diabetes mellitus (PTDM); renal transplantation

Received for publication: 11.10.07
Accepted in revised form: 16.11.07


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