Nephrology Division, Universidade Federal de São Paulo/Hospital do Rim, São Paulo, SP, Brazil.
Endocrinology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
J Diabetes Res. 2020 Mar 18;2020:1938703. doi: 10.1155/2020/1938703. eCollection 2020.
Modifiable and nonmodifiable risk factors for developing posttransplant diabetes mellitus (PTDM) have already been established in kidney transplant setting and impact adversely both patient and allograft survival. We analysed 450 recipients of living and deceased donor kidney transplants using current immunosuppressive regimen in the modern era and verified PTDM prevalence and risk factors over three-year posttransplant. Tacrolimus (85%), prednisone (100%), and mycophenolate (53%) were the main immunosuppressive regimen. Sixty-one recipients (13.5%) developed PTDM and remained in this condition throughout the study, whereas 74 (16.5%) recipients developed altered fasting glucose over time. Univariate analyses demonstrated that recipient age (46.2 ± 1.3. 40.7 ± 0.6 years old, OR 1.04; = 0.001) and pretransplant hyperglycaemia and BMI ≥ 25 kg/m (32.8% . 21.6%, OR 0.54; = 0.032 and 57.4% . 27.7%, OR 3.5; < 0.0001, respectively) were the pretransplant variables associated with PTDM. Posttransplant transient hyperglycaemia (86.8%. 18.5%, OR 0.03; = 0.0001), acute rejection ( = 0.021), calcium channel blockers ( = 0.014), TG/HDL (triglyceride/high-density lipoprotein cholesterol) ratio ≥ 3.5 at 1 year ( = 0.01) and at 3 years ( = 0.0001), and tacrolimus trough levels at months 1, 3, and 6 were equally predictors of PTDM. In multivariate analyses, pretransplant hyperglycaemia ( = 0.035), pretransplant BMI ≥ 25 kg/m ( = 0.0001), posttransplant transient hyperglycaemia ( = 0.0001), and TG/HDL ratio ≥ 3.5 at 3-year posttransplant ( = 0.003) were associated with PTDM diagnosis and maintenance over time. Early identification of risk factors associated with increased insulin resistance and decreased insulin secretion, such as pretransplant hyperglycaemia and overweight, posttransplant transient hyperglycaemia, tacrolimus trough levels, and TG/HDL ratio may be useful for risk stratification of patients to determine appropriate strategies to reduce PTDM.
可改变和不可改变的危险因素已经在肾移植患者中确立，并对患者和移植物的存活产生不利影响。我们分析了 450 例接受活体和已故供体肾移植的患者，这些患者在现代时代接受了当前的免疫抑制方案，并在移植后 3 年内验证了 PTDM 的患病率和危险因素。他克莫司（85%）、泼尼松（100%）和霉酚酸（53%）是主要的免疫抑制剂方案。61 例（13.5%）患者发生 PTDM，整个研究期间均处于该状态，而 74 例（16.5%）患者的空腹血糖随时间发生改变。单因素分析表明，受者年龄（46.2 ± 1.3 岁与 40.7 ± 0.6 岁，OR 1.04； = 0.001）和移植前高血糖及 BMI ≥ 25kg/m （32.8%与 21.6%，OR 0.54； = 0.032 和 57.4%与 27.7%，OR 3.5； < 0.0001）是与 PTDM 相关的移植前变量。移植后短暂性高血糖（86.8%与 18.5%，OR 0.03； = 0.0001）、急性排斥反应（ = 0.021）、钙通道阻滞剂（ = 0.014）、移植后 1 年和 3 年时 TG/HDL（甘油三酯/高密度脂蛋白胆固醇）比值≥3.5（ = 0.01）和 3 个月时他克莫司谷浓度是 PTDM 的预测因素。在多变量分析中，移植前高血糖（ = 0.035）、移植前 BMI ≥ 25kg/m （ = 0.0001）、移植后短暂性高血糖（ = 0.0001）和移植后 3 年时 TG/HDL 比值≥3.5（ = 0.003）与 PTDM 的诊断和维持有关。早期识别与胰岛素抵抗增加和胰岛素分泌减少相关的危险因素，如移植前高血糖和超重、移植后短暂性高血糖、他克莫司谷浓度和 TG/HDL 比值，可能有助于对患者进行风险分层，以确定降低 PTDM 的适当策略。
