Johny K V, Nampoory M R N, Costandi J N, Gupta R K, Ninan V T, Samhan M, Muzairai I, Al-Mousawi M
Department of Medicine, Faculty of Medicine, Mubarak Al-Kabeer Hospital and Hamad Al-Essa Organ Transplant Centre, PO Box 24923, Safat, Kuwait.
Diabetes Res Clin Pract. 2002 Feb;55(2):123-30. doi: 10.1016/s0168-8227(01)00290-x.
Post-transplant diabetes mellitus (PTDM) has been reported to occur in 5-15% of non-diabetic renal transplant recipients. During a 15-year period (January 1983-January 1998), 631 renal transplant recipients (TxR) were followed-up in our Centre of whom 79 (12.5%) had pre-transplant diabetes mellitus. Among the 552 TxR who were non-diabetic at pre-transplantation, 117 (21.2%) developed PTDM. The gender, native renal disease and the mode of pre-transplant dialysis did not differ in those with and without PTDM. Of the 117 TxR who developed PTDM, 63 (53.8%) were above the age of 45 years where as only 90 (20.7%) of the 435 who remained non-diabetic (NDM) were above this age (P<0.05). PTDM occurred in 115 (29.6%) recipients of Arab origin (Kuwaitis and non-Kuwaitis) where as only two (1.7%) non-Arabs developed it. There was no difference in the incidence of PTDM when prednisone and azathioprine (two drug regime) were used or with cyclosporine (triple drug regime). The incidence of acute rejection episodes did not differ among PTDM and NDM groups. The over all incidence of infections requiring hospitalisation was higher in PTDM group (1.8 episodes per patient) compared to NDM group (one episode per patient) during the study period (P<0.001). Coronary heart disease was also more frequent in PTDM (15 vs. 6%, P<0.05). The cumulative graft survival at 1, 5, 10 and 14 years in the PTDM (97, 92, 74 and 67%, respectively) and NDM groups (97, 91, 80 and 73%, respectively) was similar. However, an important cause of graft loss was death of the recipient in PTDM compared to NDM (10.7 vs. 3.6%). Similarly, the patient survival up to 14 years did not differ between PTDM and NDM groups (80 and 82%, respectively), although infection related deaths were more frequent in the PTDM group (65 vs. 49%) although not statistically significant. In conclusion, there is a high incidence of PTDM in Kuwait; age and race being the two important contributory factors. The overall patient and graft survival are not adversely affected by PTDM although infections and coronary heart disease are more frequently encountered in this group.
据报道，5%-15%的非糖尿病肾移植受者会发生移植后糖尿病（PTDM）。在1983年1月至1998年1月的15年期间，我们中心对631名肾移植受者（TxR）进行了随访，其中79名（12.5%）移植前患有糖尿病。在移植前无糖尿病的552名TxR中，117名（21.2%）发生了PTDM。发生PTDM和未发生PTDM的患者在性别、原发病肾病及移植前透析方式方面无差异。在发生PTDM的117名TxR中，63名（53.8%）年龄超过45岁，而在435名仍未患糖尿病（NDM）的患者中，只有90名（20.7%）超过这个年龄（P<0.05）。阿拉伯裔（科威特人和非科威特人）受者中115名（29.6%）发生了PTDM，而非阿拉伯裔中只有2名（1.7%）发生。使用泼尼松和硫唑嘌呤（二联用药方案）或环孢素（三联用药方案）时，PTDM的发生率无差异。PTDM组和NDM组急性排斥反应的发生率无差异。在研究期间，PTDM组需要住院治疗的感染总体发生率高于NDM组（每位患者1.8次 vs. 每位患者1次，P<0.001）。PTDM组冠心病的发生率也更高（15% vs. 6%，P<0.05）。PTDM组和NDM组在1年、5年、10年和14年时的累积移植物存活率相似（分别为97%、92%、74%和67%）。然而，与NDM组相比，PTDM组移植物丢失的一个重要原因是受者死亡（10.7% vs. 3.6%）。同样，PTDM组和NDM组至14年的患者存活率无差异（分别为80%和82%），尽管PTDM组感染相关死亡更常见（65% vs. 49%），但差异无统计学意义。总之，科威特PTDM的发生率很高；年龄和种族是两个重要的促成因素。尽管该组感染和冠心病更常见，但PTDM对患者和移植物的总体存活率没有不利影响。
