Sánchez-Pérez B, Aranda Narváez J M, Santoyo Santoyo J, Fernández-Aguilar J L, Suárez Muñoz M A, González-Sánchez A J, Pérez Daga J A, Ramírez Plaza C P, Carrasco Campos J, Jiménez Mazure C, Becerra Ortíz R
Hepatobiliary and Transplant Unit, Carlos Haya University Hospital, Málaga, Spain.
Transplant Proc. 2008 Nov;40(9):2994-6. doi: 10.1016/j.transproceed.2008.08.116.
New-onset posttransplantation diabetes mellitus (PTDM), with an incidence of 10% to 30%, increased graft and patient morbidity and mortality. Such causal factors as age, obesity, therapy, immunosuppression, and hepatitis C virus (HCV) contribute to this disease.
We sought to determine the incidence of PTDM and impaired fasting glucose (IFG) concentration in transplant recipients to define the causal variables.
The study included 127 patients. Patients with pretransplantation diabetes and those with less than 6 months of follow-up were excluded. A descriptive observational study to assess the association between PTDM and IFG and the immunosuppression therapy used was performed by monitoring the potential confounding variables of age, obesity, and HCV.
During mean follow-up of 73.7 months (range, 7-120 mo), 93 patients received cyclosporine A (CyA) and 34 received tacrolimus (Tac) therapy. Thirty patients (23.6%) developed PTDM or IFG including 15 (16%; PTDM, six IFG, nine) in the CyA group and 15 (PTDM, seven; IFG, eight) in the Tacrolimus group (P = .001; odds ratio [OR], 4.1). They were homogeneous with respect to confounding variables except for HCV (P = .01). Of the 55 patients with HCV infection, 12 developed PTDM or IFG, including three in the CyA group and nine in the tacrolimus group (P = .03; OR, 7.7), whereas in the 72 patients without HCV infection, the CyA or tacrolimus association with PTDM or IFG was significant (P = .05), Mantel-Haenszel test; OR, 4.9). The interaction between HCV and immunosuppression therapy was primarily produced in the IFG group (HCV-positive; P = .008; OR, 8).
We observed an association between the use of tacrolimus and the development of PTDM or IFG. There is greater risk in HCV-positive patients, in particular in relation to IFG. The choice of immunosuppressive treatment might be decided on the basis of the patient's pretransplantation status.
新发移植后糖尿病（PTDM）的发病率为10%至30%，会增加移植物及患者的发病率和死亡率。年龄、肥胖、治疗、免疫抑制及丙型肝炎病毒（HCV）等病因与该病有关。
我们试图确定移植受者中PTDM和空腹血糖受损（IFG）浓度的发生率，以明确因果变量。
该研究纳入了127例患者。排除移植前患有糖尿病及随访时间少于6个月的患者。通过监测年龄、肥胖和HCV等潜在混杂变量，进行了一项描述性观察研究，以评估PTDM和IFG与所用免疫抑制治疗之间的关联。
在平均73.7个月（范围7至120个月）的随访期间，93例患者接受环孢素A（CyA）治疗，34例接受他克莫司（Tac）治疗。30例患者（23.6%）发生了PTDM或IFG，其中CyA组有15例（16%；PTDM 6例，IFG 9例），他克莫司组有15例（PTDM 7例，IFG 8例）（P = .001；比值比[OR]，4.1）。除HCV外，两组在混杂变量方面具有同质性（P = .01）。在55例HCV感染患者中，12例发生了PTDM或IFG，其中CyA组3例，他克莫司组9例（P = .03；OR，7.7），而在72例未感染HCV的患者中，CyA或他克莫司与PTDM或IFG之间的关联具有显著性（P = .05），Mantel-Haenszel检验；OR，4.9）。HCV与免疫抑制治疗之间的相互作用主要发生在IFG组（HCV阳性；P = .008；OR，8）。
我们观察到他克莫司的使用与PTDM或IFG的发生之间存在关联。HCV阳性患者的风险更高，尤其是在IFG方面。免疫抑制治疗的选择可根据患者移植前的状况来决定。
