#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Comparison of post-transplantation diabetes mellitus incidence and risk factors between kidney and liver transplantation patients


Autoři: Vidit N. Munshi aff001;  Soroush Saghafian aff002;  Curtiss B. Cook aff003;  K. Tuesday Werner aff003;  Harini A. Chakkera aff003
Působiště autorů: PhD Program in Health Policy, Harvard University, Cambridge, Massachusetts, United States of America aff001;  Harvard Kennedy School, Harvard University, Cambridge, Massachusetts, United States of America aff002;  Mayo Clinic Arizona, Scottsdale, Arizona, United States of America aff003
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
prolekare.web.journal.doi_sk: https://doi.org/10.1371/journal.pone.0226873

Souhrn

Background

Most prior studies characterizing post-transplantation diabetes mellitus (PTDM) have been limited to single-cohort, single-organ studies. This retrospective study determined PTDM across organs by comparing incidence and risk factors among 346 liver and 407 kidney transplant recipients from a single center.

Methods

Univariate and multivariate regression-based analyses were conducted to determine association of various risk factors and PTDM in the two cohorts, as well as differences in glucometrics and insulin use across time points.

Results

There was a higher incidence of PTDM among liver versus kidney transplant recipients (30% vs. 19%) at 1-year post-transplant. Liver transplant recipients demonstrated a 337% higher odds association to PTDM (OR 3.37, 95% CI (1.38–8.25), p<0.01). 1-month FBG was higher in kidney patients (135 mg/dL vs 104 mg/dL; p < .01), while 1-month insulin use was higher in liver patients (61% vs 27%, p < .01). Age, BMI, insulin use, and inpatient FBG were also significantly associated with differential PTDM risk.

Conclusions

Kidney and liver transplant patients have different PTDM risk profiles, both in terms of absolute PTDM risk as well as time course of risk. Management of this population should better reflect risk heterogeneity to short-term need for insulin therapy and potentially long-term outcomes.

Klíčová slova:

Hyperglycemia – Insulin – Steroids – Kidneys – Glucose – Renal transplantation – Liver transplantation – diabetes mellitus


Zdroje

1. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003;3(2):178–85. doi: 10.1034/j.1600-6143.2003.00010.x 12603213

2. Kasiske BL, Chakkera HA, Roel J. Explained and unexplained ischemic heart disease risk after renal transplantation. J Am Soc Nephrol. 2000;11(9):1735–43. 10966499

3. Ghisdal L, Van Laecke S, Abramowicz MJ, Vanholder R, Abramowicz D. New-onset diabetes after renal transplantation: risk assessment and management. Diabetes Care. 2012;35(1):181–8. doi: 10.2337/dc11-1230 22187441

4. Davidson J, Wilkinson A, Dantal J, Dotta F, Haller H, Hernandez D, et al. New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation. 2003;75(10 Suppl):SS3–24.

5. Sharif A, Hecking M, de Vries AP, Porrini E, Hornum M, Rasoul-Rockenschaub S, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014;14(9):1992–2000. doi: 10.1111/ajt.12850 25307034

6. Baid S, Cosimi AB, Farrell ML, Schoenfeld DA, Feng S, Chung RT, et al. Posttransplant diabetes mellitus in liver transplant recipients: risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation. 2001;72(6):1066–72. doi: 10.1097/00007890-200109270-00015 11579302

7. Knobler H, Stagnaro-Green A, Wallenstein S, Schwartz M, Roman SH. Higher incidence of diabetes in liver transplant recipients with hepatitis C. J Clin Gastroenterol. 1998;26(1):30–3. doi: 10.1097/00004836-199801000-00009 9492860

8. Ye X, Kuo HT, Sampaio MS, Jiang Y, Bunnapradist S. Risk factors for development of new-onset diabetes mellitus after transplant in adult lung transplant recipients. Clin Transplant. 2011;25(6):885–91. doi: 10.1111/j.1399-0012.2010.01383.x 21175848

9. Pham PT, Pham PM, Pham SV, Pham PA, Pham PC. New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes. 2011;4:175–86. doi: 10.2147/DMSO.S19027 21760734

10. Kim WR, Lake JR, Smith JM, Skeans MA, Schladt DP, Edwards EB, et al. OPTN/SRTR 2015 Annual Data Report: Liver. Am J Transplant. 2017;17 Suppl 1:174–251.

11. Hart A, Smith JM, Skeans MA, Gustafson SK, Stewart DE, Cherikh WS, et al. OPTN/SRTR 2015 Annual Data Report: Kidney. Am J Transplant. 2017;17 Suppl 1:21–116.

12. Crutchlow MF, Bloom RD. Transplant-associated hyperglycemia: a new look at an old problem. Clin J Am Soc Nephrol. 2007;2(2):343–55. doi: 10.2215/CJN.03671106 17699434

13. Carter SA, Kitching AR, Johnstone LM. Four pediatric patients with autosomal recessive polycystic kidney disease developed new-onset diabetes after renal transplantation. Pediatr Transplant. 2014;18(7):698–705. doi: 10.1111/petr.12332 25118046

14. Gaynor JJ, Ciancio G, Guerra G, Sageshima J, Hanson L, Roth D, et al. Multivariable risk of developing new onset diabetes after transplant-results from a single-center study of 481 adult, primary kidney transplant recipients. Clin Transplant. 2015;29(4):301–10. doi: 10.1111/ctr.12510 25581205

15. Kuo HT, Lau C, Sampaio MS, Bunnapradist S. Pretransplant risk factors for new-onset diabetes mellitus after transplant in pediatric liver transplant recipients. Liver Transpl. 2010;16(11):1249–56. doi: 10.1002/lt.22139 21031540

16. Luan FL, Langewisch E, Ojo A. Metabolic syndrome and new onset diabetes after transplantation in kidney transplant recipients. Clin Transplant. 2010;24(6):778–83. doi: 10.1111/j.1399-0012.2009.01194.x 20047609

17. Lv C, Chen M, Xu M, Xu G, Zhang Y, He S, et al. Influencing factors of new-onset diabetes after a renal transplant and their effects on complications and survival rate. PLoS One. 2014;9(6):e99406. doi: 10.1371/journal.pone.0099406 24911157

18. Palepu S, Prasad GV. New-onset diabetes mellitus after kidney transplantation: Current status and future directions. World J Diabetes. 2015;6(3):445–55. doi: 10.4239/wjd.v6.i3.445 25897355

19. Park SC, Yoon YD, Jung HY, Kim KH, Choi JY, Park SH, et al. Effect of transient post-transplantation hyperglycemia on the development of diabetes mellitus and transplantation outcomes in kidney transplant recipients. Transplant Proc. 2015;47(3):666–71. doi: 10.1016/j.transproceed.2014.11.053 25891707

20. Rodrigo E, Fernandez-Fresnedo G, Valero R, Ruiz JC, Pinera C, Palomar R, et al. New-onset diabetes after kidney transplantation: risk factors. J Am Soc Nephrol. 2006;17(12 Suppl 3):S291–5.

21. Pirsch JD, Henning AK, First MR, Fitzsimmons W, Gaber AO, Reisfield R, et al. New-Onset Diabetes After Transplantation: Results From a Double-Blind Early Corticosteroid Withdrawal Trial. Am J Transplant. 2015;15(7):1982–90. doi: 10.1111/ajt.13247 25881802

22. Boloori A, Saghafian S, Chakkera HA, Cook CB. Characterization of Remitting and Relapsing Hyperglycemia in Post-Renal-Transplant Recipients. PLoS One. 2015;10(11):e0142363. doi: 10.1371/journal.pone.0142363 26551468

23. Boloori A, Saghafian S, Chakkera HA, Cook CB. Data-Driven Management of Post-Transplant Medications: An Ambiguous Partially Observable Markov Decision Process Approach. Manufacturing and Service Operations Management (forthcoming). 2019.

24. Chakkera HA, Weil EJ, Castro J, Heilman RL, Reddy KS, Mazur MJ, et al. Hyperglycemia during the immediate period after kidney transplantation. Clin J Am Soc Nephrol. 2009;4(4):853–9. doi: 10.2215/CJN.05471008 19339426

25. Werner KT, Mackey PA, Castro JC, Carey EJ, Chakkera HA, Cook CB. Hyperglycemia during the immediate period following liver transplantation. Future Sci OA. 2016;2(1):FSO97. doi: 10.4155/fsoa-2015-0010 28031946

26. Cook CB, Castro JC, Schmidt RE, Gauthier SM, Whitaker MD, Roust LR, et al. Diabetes care in hospitalized noncritically ill patients: More evidence for clinical inertia and negative therapeutic momentum. J Hosp Med. 2007;2(4):203–11. doi: 10.1002/jhm.188 17683100

27. Subramanian S, Trence DL. Immunosuppressive agents: effects on glucose and lipid metabolism. Endocrinol Metab Clin North Am. 2007;36(4):891–905; vii. doi: 10.1016/j.ecl.2007.07.003 17983927

28. Penfornis A, Kury-Paulin S. Immunosuppressive drug-induced diabetes. Diabetes Metab. 2006;32(5 Pt 2):539–46.

29. American Diabetes A. Standards of Medical Care in Diabetes-2017 Abridged for Primary Care Providers. Clin Diabetes. 2017;35(1):5–26. doi: 10.2337/cd16-0067 28144042


Článok vyšiel v časopise

PLOS One


2020 Číslo 1
Najčítanejšie tento týždeň
Najčítanejšie v tomto čísle
Kurzy

Zvýšte si kvalifikáciu online z pohodlia domova

Získaná hemofilie - Povědomí o nemoci a její diagnostika
nový kurz

Eozinofilní granulomatóza s polyangiitidou
Autori: doc. MUDr. Martina Doubková, Ph.D.

Všetky kurzy
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#