移植后短暂高血糖对肾移植受者糖尿病发生及移植结局的影响。
Effect of transient post-transplantation hyperglycemia on the development of diabetes mellitus and transplantation outcomes in kidney transplant recipients.
作者信息
Park S-C, Yoon Y-D, Jung H-Y, Kim K-H, Choi J-Y, Park S-H, Kim C-D, Kim Y-L, Kim H-K, Huh S, Cho J-H
机构信息
Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
Department of Surgery, Kyungpook National University School of Medicine, Daegu, Korea.
出版信息
Transplant Proc. 2015 Apr;47(3):666-71. doi: 10.1016/j.transproceed.2014.11.053.
BACKGROUND
Hyperglycemia occurs frequently after kidney transplantation and may be reversed when the dosage of the immunosuppressive agents is tapered. However, the effect of transient post-transplantation hyperglycemia (PTH) on transplantation outcomes is not well described.
METHODS
Kidney transplant recipients without diabetes who underwent kidney transplantation between 2001 and 2012 were enrolled in the study. Transient PTH was defined as recovery from PTH without further antidiabetic therapy and the maintenance of glycated hemoglobin levels <6.5% at 1 year after transplantation. Persistent PTH until 1 year after transplantation was considered to be new-onset diabetes after transplantation (NODAT). The factors associated with increased risk of PTH were analyzed. We compared the development of diabetes mellitus, cardiovascular disease, and other transplantation outcomes among patients with no PTH, transient PTH, and NODAT.
RESULTS
Among 176 kidney transplant recipients, 106 (60.2%) developed PTH and 58 (54.7%) of 106 patients with PTH had transient PTH. Older age, high body mass index (BMI), and female gender were independent risk factors for transient PTH. The incidence of diabetes was not significantly different between patients with no PTH and those with transient PTH. The incidence of cardiovascular disease was significantly increased in NODAT group compared with that in no PTH and transient PTH groups. However, the incidences of acute rejection, allograft loss, and patient death were comparable among the three groups.
CONCLUSIONS
Transient hyperglycemia after kidney transplantation was found to be associated with older age, high body mass index, and female gender. Transient elevation of blood glucose level did not affect post-transplantation outcomes, including diabetes mellitus and cardiovascular disease. However, patients with NODAT should be carefully monitored for the occurrence of cardiovascular disease.
背景
肾移植后高血糖症频繁发生，当免疫抑制剂剂量减小时可能会逆转。然而，移植后短暂高血糖（PTH）对移植结局的影响尚未得到充分描述。
方法
纳入2001年至2012年间接受肾移植且无糖尿病的肾移植受者。短暂性PTH定义为无需进一步抗糖尿病治疗即可从PTH恢复，且移植后1年糖化血红蛋白水平维持在<6.5%。移植后持续PTH至1年被认为是移植后新发糖尿病（NODAT）。分析与PTH风险增加相关的因素。我们比较了无PTH、短暂性PTH和NODAT患者中糖尿病、心血管疾病及其他移植结局的发生情况。
结果
在176例肾移植受者中，106例（60.2%）发生了PTH，其中106例PTH患者中有58例（54.7%）为短暂性PTH。年龄较大、体重指数（BMI）较高和女性是短暂性PTH的独立危险因素。无PTH患者和短暂性PTH患者的糖尿病发病率无显著差异。与无PTH和短暂性PTH组相比，NODAT组的心血管疾病发病率显著增加。然而，三组的急性排斥反应、移植肾丢失和患者死亡发生率相当。
结论
肾移植后短暂性高血糖与年龄较大、体重指数较高和女性有关。血糖水平的短暂升高并不影响包括糖尿病和心血管疾病在内的移植后结局。然而，应密切监测NODAT患者心血管疾病的发生情况。
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