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接受基于他克莫司免疫抑制治疗的西班牙裔和白种人肾移植后糖尿病

Post-Transplant Diabetes Mellitus After Kidney Transplant in Hispanics and Caucasians Treated with Tacrolimus-Based Immunosuppression.

作者信息

Baron Pedro W, Infante Sergio, Peters Regina, Tilahun Jerusalem, Weissman Jill, Delgado Lauren, Kore Arputharaj Higgins, Beeson W Lawrence, de Vera Michael E

机构信息

Transplantation Institute, Loma Linda University Medical Center, Loma Linda, CA, USA.

Department of Internal Medicine, Division of Nephrology, Loma Linda University Medical Center, Loma Linda, CA, USA.

出版信息

Ann Transplant. 2017 May 23;22:309-314. doi: 10.12659/aot.903079.

Abstract

BACKGROUND Development of post-transplant diabetes mellitus after kidney transplant (PTDM) significantly increases kidney graft loss and mortality. Several risk factors for PTDM have been reported, including Hispanic ethnicity and the use of calcineurin inhibitors and corticosteroids. The incidence and impact of PTDM in the Hispanic kidney transplant population is unknown. MATERIAL AND METHODS We retrospectively reviewed the medical records of 155 Hispanic and 124 Caucasian patients, who were not diabetics and underwent kidney transplant between January 2006 and December 2011. We analyzed their clinical outcomes at 12 months post-transplant, including the incidence of PTDM, acute rejection rates, and patient and graft survival. RESULTS Hispanics who developed PTDM (n=22) were more than 10 years older and had higher body mass index (BMI) than Hispanics without PTDM (p<0.001 and p=0.001, respectively). Caucasians with PTDM (n=13) were non-significantly older (2.5 years) and had higher BMI than Caucasians without PTDM (p=0.526, p=0.043, respectively). The incidence of PTDM was not significantly different between Hispanics and Caucasians treated with tacrolimus-based immunosuppression (14.2% and 10.5%, respectively). CONCLUSIONS PTDM did not cause significant difference in short-term outcomes after kidney transplant in Hispanics or Caucasians. Larger multicenter prospective and long-term clinical trials are needed to validate these findings.

摘要

背景

肾移植后发生移植后糖尿病(PTDM)会显著增加肾移植失败和死亡风险。已有多项PTDM的危险因素被报道,包括西班牙裔种族以及使用钙调神经磷酸酶抑制剂和皮质类固醇。PTDM在西班牙裔肾移植人群中的发病率及影响尚不清楚。

材料与方法

我们回顾性分析了155例西班牙裔和124例非糖尿病白人患者的病历,这些患者于2006年1月至2011年12月期间接受了肾移植。我们分析了他们移植后12个月的临床结局,包括PTDM的发病率、急性排斥反应率以及患者和移植肾的存活率。

结果

发生PTDM的西班牙裔患者(n = 22)比未发生PTDM的西班牙裔患者年龄大10岁以上且体重指数(BMI)更高(分别为p < 0.001和p = 0.001)。发生PTDM的白人患者(n = 13)比未发生PTDM的白人患者年龄稍大(2.5岁)且BMI更高(分别为p = 0.526,p = 0.043)。接受他克莫司免疫抑制治疗的西班牙裔和白人患者中PTDM的发病率无显著差异(分别为14.2%和10.5%)。

结论

PTDM在西班牙裔或白人肾移植后的短期结局中未造成显著差异。需要开展更大规模的多中心前瞻性长期临床试验来验证这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/821f/6248042/5038d2c9ce5a/anntransplant-22-309-g001.jpg

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