Miles A M, Sumrani N, Horowitz R, Homel P, Maursky V, Markell M S, Distant D A, Hong J H, Sommer B G, Friedman E A
Department of Medicine, SUNY Health Science Center at Brooklyn, New York 11203, USA.
Transplantation. 1998 Feb 15;65(3):380-4. doi: 10.1097/00007890-199802150-00014.
Despite use of lower doses of corticosteroid hormones after renal allotransplantation in the era of cyclosporine and tacrolimus, posttransplant diabetes mellitus remains a common clinical problem.
We prospectively investigated the effect of posttransplant diabetes on long-term (mean follow-up, 9.3+/-1.5 years) graft and patient survival in the 11.8% of our renal transplant population (n = 40) who developed diabetes after kidney transplantation, and we compared outcome in 38 randomly chosen nondiabetic control patients who had received transplants concurrently.
Twelve-year graft survival in diabetic patients was 48%, compared with 70% in control patients (P = 0.04), and Cox's regression analysis revealed diabetes to be a significant predictor of graft loss (P = 0.04, relative risk = 3.72) independent of age, sex, and race. Renal function at 5 years as assessed by serum creatinine level was inferior in diabetic patients compared to control patients (2.9+/-2.6 vs. 2.0+/-0.07 mg/dl, P = 0.05). Two diabetic patient who experienced graft loss had a clinical course and histological features consistent with diabetic nephropathy; other diabetes-related morbidity in patients with posttransplant diabetes included ketoacidosis, hyperosmolar coma or precoma, and sensorimotor peripheral neuropathy. Patient survival at 12 years was similar in diabetic and control patients (71% vs. 74%).
Posttransplant diabetes mellitus is associated with impaired long-term renal allograft survival and function, complications similar to those in non-transplant-associated diabetes may occur in posttransplant diabetes, and, hence, as in non-transplant-associated diabetes, tight glycemic control may also be warranted in patients with posttransplant diabetes.
在环孢素和他克莫司时代，尽管肾移植术后使用了较低剂量的皮质类固醇激素，但移植后糖尿病仍然是一个常见的临床问题。
我们前瞻性地研究了移植后糖尿病对我们肾移植人群中11.8%（n = 40）肾移植后发生糖尿病患者的长期（平均随访9.3±1.5年）移植物和患者生存的影响，并将结果与38例随机选择的同期接受移植的非糖尿病对照患者进行了比较。
糖尿病患者的12年移植物存活率为48%，而对照患者为70%（P = 0.04），Cox回归分析显示糖尿病是移植物丢失的一个重要预测因素（P = 0.04，相对风险 = 3.72），与年龄、性别和种族无关。与对照患者相比，糖尿病患者5年时通过血清肌酐水平评估的肾功能较差（2.9±2.6 vs. 2.0±0.07 mg/dl，P = 0.05）。两名发生移植物丢失的糖尿病患者的临床病程和组织学特征与糖尿病肾病一致；移植后糖尿病患者的其他糖尿病相关并发症包括酮症酸中毒、高渗性昏迷或前驱昏迷以及感觉运动性周围神经病变。糖尿病患者和对照患者的12年患者生存率相似（71% vs. 74%）。
移植后糖尿病与长期肾移植移植物存活和功能受损有关，移植后糖尿病可能发生与非移植相关糖尿病类似的并发症，因此，与非移植相关糖尿病一样，移植后糖尿病患者也可能需要严格控制血糖。
