Siraj E S, Abacan C, Chinnappa P, Wojtowicz J, Braun W
Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio, USA.
Transplant Proc. 2010 Jun;42(5):1685-9. doi: 10.1016/j.transproceed.2009.12.062.
Although our understanding of the risk factors involved in the occurrence of posttransplant diabetes mellitus (PTDM) as well as its outcomes has improved, it still remains incomplete. Our study attempts to analyze the risk factors as well as the outcomes associated with PTDM in the renal transplant patients at the Cleveland Clinic.
Our study is a retrospective, case-control study. We screened 209 charts of 217 patients who received single-organ kidney transplant at the Cleveland Clinic between January 1996 and December 1998. PTDM was defined by the American Diabetes Association criteria of either a fasting blood glucose >or=126 mg/dL or random blood sugars >or=200 mg/dL confirmed on a second occasion. Kidney transplant recipients who developed PTDM (cases) were compared with kidney transplant recipients who did not develop diabetes but were matched for the time of transplant (controls).
Forty-nine patients (23%) developed PTDM. The data of 47 cases and 47 controls were analyzed. Age >or=40 years, body mass index >or=30, pretransplant triglyceride levels >150 mg/dL, and presence of graft rejection were significant risk factors for developing PTDM. Smoking was associated with increased risk of PTDM but failed to achieve statistical significance. Compared with controls, PTDM patients had higher risk of cardiovascular disease, infections, and graft rejection.
Our results show that PTDM is a significant problem after kidney transplantation, and those who have high risk should be closely monitored after transplant and aggressively treated if they develop diabetes to minimize the risk of complications.
尽管我们对移植后糖尿病（PTDM）发生的危险因素及其后果的理解有所改善，但仍不完整。我们的研究试图分析克利夫兰诊所肾移植患者中与PTDM相关的危险因素及其后果。
我们的研究是一项回顾性病例对照研究。我们筛查了1996年1月至1998年12月在克利夫兰诊所接受单器官肾移植的217例患者的209份病历。PTDM根据美国糖尿病协会的标准定义，即空腹血糖≥126mg/dL或随机血糖≥200mg/dL，且需在第二次检测时得到确认。将发生PTDM的肾移植受者（病例组）与未患糖尿病但移植时间相匹配的肾移植受者（对照组）进行比较。
49例患者（23%）发生了PTDM。分析了47例病例和47例对照的数据。年龄≥40岁、体重指数≥30、移植前甘油三酯水平>150mg/dL以及发生移植排斥反应是发生PTDM的显著危险因素。吸烟与PTDM风险增加相关，但未达到统计学显著性。与对照组相比，PTDM患者发生心血管疾病、感染和移植排斥反应的风险更高。
我们的结果表明，PTDM是肾移植后的一个重要问题，高危患者移植后应密切监测，若发生糖尿病应积极治疗，以将并发症风险降至最低。
