Porrini Esteban, Delgado Patricia, Alvarez Alejandra, Cobo Marian, Pérez Lourdes, González-Posada José M, Hortal Luis, Gallego Roberto, García José J, Checa Maria, Morales Adelaida, Salido Eduardo, Hernández Domingo, Torres Armando
Nephrology Section and Research Unit, Hospital Universitario de Canarias, Ofra S/N, 38320 La Laguna, Tenerife, Spain.
Nephrol Dial Transplant. 2008 Apr;23(4):1436-41. doi: 10.1093/ndt/gfm762. Epub 2007 Nov 19.
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).
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.
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.
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.
在普通人群中，胰岛素抵抗先于显性糖尿病出现，而高甘油三酯血症是该病症的可靠标志物。因此，等待名单上患有高甘油三酯血症的患者在移植后可能有患新发糖尿病（NODAT）的风险。目的：我们研究移植前甘油三酯（TG）水平是否是NODAT的危险因素，以及它们是否与钙调神经磷酸酶抑制剂（CNI）的类型产生联合作用。
我们分析了1999年至2003年间连续接受移植的314例非糖尿病受者[215例接受环孢素A（CsA）治疗；99例接受他克莫司（Tacro）治疗]，平均随访34个月。结局为根据ADA标准定义的NODAT。
81例受者（25.8%）发生了NODAT。多因素分析纳入了决定CNI分配的因素的倾向评分，结果显示年龄（OR：1.06；95%CI：1.03 - 1.09）、移植前BMI（OR：1.1；95%CI：1.02 - 1.17）、TG水平（每增加50mg/dl，OR：1.3；95%CI：1.07 - 1.6）和治疗过的急性排斥反应（OR：4.8；95%CI：3 - 11），而非CNI的类型，是NODAT的独立危险因素。观察到移植前TG与CNI类型之间存在显著交互作用。以CsA作为参照，Tacro与移植前高甘油三酯血症（≥200mg/dl）联合出现时发生NODAT的OR为3.26（1.4 - 7.8），而移植前TG水平<200mg/dl的Tacro受者发生NODAT的OR为0.75（0.34 - 1.6）。
移植前高甘油三酯血症仅在接受Tacro治疗的受者中是NODAT的危险因素；这凸显了移植前胰岛素抵抗在NODAT发病机制中的重要性。
