Mazali F Cr, Lalli Cr A, Alves-Filho G, Mazzali M
Division of Nephrology, State University of Campinas, UNICAMP, São Paulo, Brazil.
Transplant Proc. 2008 Apr;40(3):764-6. doi: 10.1016/j.transproceed.2008.03.018.
Posttransplant diabetes mellitus (PTDM) is common post transplantation and is associated with tacrolimus (TAC) and steroid therapy. The aim of the present study was to analyze the incidences of PTDM and associated risk factors.
We selected renal transplant recipients treated with TAC, mycophenolate mofetil (MM), and steroids. Exclusion criteria were recipients <18 years old, history of diabetes, recipients of kidney/pancreas, and/or those receiving cyclosporine or sirolimus. PTDM was defined as glucose >126 mg/dL, with or without drug therapy.
Among 67 patients who fulfilled the inclusion criteria, 18 (26.8%) developed PTDM within 2 months of transplantation. Compared with normal glucose patients, the PTDM group was older, male, received a kidney from deceased donors, and showed higher pretransplant glucose levels. No differences were noticed in renal function or daily dose of TAC or steroids. However, TAC trough levels in the first month were higher among the PTDM group, despite the lower dose per kilogram. After 1 year of follow-up, weight gain as well as daily TAC per kilogram dose was less among PTDM patients. Analysis of potential risk factors showed a higher incidence of hepatitis C virus infection in the PTDM group, as well as a higher frequency of HLA DR13.
The incidence of PTDM diagnosed in the early posttransplant period in the present series was 26.8%. Risk factors included older age, male gender, recipients of kidneys from deceased donors, hepatitis C virus infection, higher pretransplant glucose levels, and higher TAC trough levels during the first month posttransplant.
移植后糖尿病（PTDM）在移植后很常见，与他克莫司（TAC）和类固醇治疗有关。本研究的目的是分析PTDM的发病率及相关危险因素。
我们选择了接受TAC、霉酚酸酯（MM）和类固醇治疗的肾移植受者。排除标准为年龄<18岁、有糖尿病史、肾/胰腺移植受者和/或接受环孢素或西罗莫司治疗的患者。PTDM定义为血糖>126 mg/dL，无论是否接受药物治疗。
在符合纳入标准的67例患者中，18例（26.8%）在移植后2个月内发生PTDM。与血糖正常的患者相比，PTDM组患者年龄更大、为男性、接受的是来自已故供体的肾脏，且移植前血糖水平更高。在肾功能、TAC或类固醇的每日剂量方面未发现差异。然而，尽管PTDM组每公斤剂量较低，但第一个月的TAC谷浓度较高。随访1年后，PTDM患者的体重增加以及每公斤每日TAC剂量较少。对潜在危险因素的分析显示，PTDM组丙型肝炎病毒感染的发生率较高，以及HLA DR13的频率较高。
本系列研究中移植后早期诊断的PTDM发病率为26.8%。危险因素包括年龄较大、男性、接受来自已故供体的肾脏、丙型肝炎病毒感染、移植前血糖水平较高以及移植后第一个月的TAC谷浓度较高。
