Burroughs Thomas E, Swindle Jason P, Salvalaggio Paolo R, Lentine Krista L, Takemoto Steven K, Bunnapradist Suphamai, Brennan Daniel C, Schnitzler Mark A
Department of Internal Medicine, Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, USA.
Transplantation. 2009 Aug 15;88(3):367-73. doi: 10.1097/TP.0b013e3181ae67f0.
Risk of new-onset diabetes after transplant (NODAT) is well characterized for adults but much less understood in pediatric transplant. This study examines the incidence and risk factors of NODAT in pediatric renal transplant patients.
The incidence of NODAT over the first 3 years after transplant was examined with the United States Renal Data System data for primary renal transplant recipients (ages 0-21 years, transplanted between 1995 and 2004) with Medicare primary. Patients had no evidence of diabetes before transplant. We estimated the cumulative incidence rate and used Cox proportional hazards regression to identify the risk factors for NODAT. Propensity scores were calculated for immunosuppression choice to adjust for potential confounding factors.
Two thousand one hundred sixty-eight recipients with valid immunosuppression records and without pretransplant evidence of diabetes were included. Unadjusted, cumulative NODAT incidence at 3 years posttransplant was 7.1%. Significant factors for increased risk of NODAT included cytomegalovirus D+/R- serostatus (adjusted hazard ratio [aHR]=1.60), age 13 to 18 years (aHR=2.18), age 19 to 21 years (aHR=2.60), body mass index more than or equal to 30 kg/m (aHR=2.17), and use of tacrolimus (aHR=1.51). We failed to find any significant relationships between NODAT and graft failure or death.
Although the incidence of NODAT among patients aged 0 to 21 years is lower than that for adult patients, it is higher than suggested by earlier research and may represent an increase over time. The lack of association between NODAT and graft or failure death has important implications for posttransplant care. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.
移植后新发糖尿病（NODAT）在成人中的风险已得到充分研究，但在儿科移植中的了解却少得多。本研究探讨了儿科肾移植患者中NODAT的发病率及危险因素。
利用美国肾脏数据系统中医疗保险主要覆盖的原发性肾移植受者（年龄0至21岁，于1995年至2004年间接受移植）的数据，研究移植后头3年NODAT的发病率。患者在移植前无糖尿病证据。我们估计了累积发病率，并使用Cox比例风险回归来确定NODAT的危险因素。计算免疫抑制选择的倾向得分，以调整潜在的混杂因素。
纳入了2168名有有效免疫抑制记录且移植前无糖尿病证据的受者。未经调整的移植后3年NODAT累积发病率为7.1%。NODAT风险增加的显著因素包括巨细胞病毒D+/R-血清学状态（调整后风险比[aHR]=1.60）、13至18岁（aHR=2.18）、19至21岁（aHR=2.60）、体重指数大于或等于30kg/m（aHR=2.17）以及使用他克莫司（aHR=1.51）。我们未发现NODAT与移植失败或死亡之间存在任何显著关系。
尽管0至21岁患者中NODAT的发病率低于成人患者，但高于早期研究所提示的发病率，且可能随时间增加。NODAT与移植失败或死亡缺乏关联对移植后护理具有重要意义。更清楚地了解危险因素有助于指导移植后监测和临床决策。
