Development and Clinical Implication of Post- transplant Diabetes Mellitus.
- Author:
Jinmo KANG
1
;
Jongwon HA
;
Yang Jin PARK
;
Taeseung LEE
;
In Mok JUNG
;
Jungkee CHUNG
;
Yon Su KIM
;
Curie AHN
;
Young Min CHO
;
Kyung Soo PARK
;
Sang Joon KIM
Author Information
1. Department of Surgery, Dankook University College of Medicine, Cheonan, Korea.
- Publication Type:Original Article
- Keywords:
PTDM;
Immunosuppression;
Risk factor
- MeSH:
Cyclosporine;
Diabetes Mellitus*;
Humans;
Immunosuppression;
Incidence;
Medical Records;
Myocardial Infarction;
Obesity;
Retrospective Studies;
Risk Factors;
Seoul;
Stroke;
Tacrolimus;
Transplants
- From:The Journal of the Korean Society for Transplantation
2007;21(2):262-268
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: It has been known that the incidence of post-transplant diabetes mellitus (PTDM) is variable according to the immunosuppressant used. The goals of this study are to uncover the factors associated with the development of PTDM and to clarify the fate of PTDM. METHODS: The medical records of 267 patients who underwent renal transplant between 1996 and December 2002 at Seoul National University Hospital were retrospectively reviewed. Patients were divided into three groups: cyclosporine group (CsA, n=179), high tacrolimus group (HFK, mean trough level during post-transplant 2 week>15 ng/m, n=33) and low tacrolimus group (LFK, mean trough level during post- transplant 2 week< or =15 ng/mL, n=55). The incidence, risk factors of PTDM and clinical fate were analyzed. RESULTS: PTDM developed in 46 (17.2%) patients. PTDM incidence of HFK group (60.6%) was significantly higher than CsA group (10.1%) and LFK group (14.5%) (P=0.000). Tacrolimus use, age at the time of transplantation (>40year), family history of diabetes and obesity (BMI>25) were the risk factors for PTDM development. Incidences of associated clinical events, such as acute rejection, cerebrovascular accident, myocardial infarction, or infection were not different between PTDM and non-PTDM group. PTDM was resolved in 13 out of 46 patients (28.3%). Only 7 out of 33 patients (21.2%) in whom PTDM persisted lost their graft. CONCLUSION: PTDM incidence was higher in HFK group. So, LFK protocol is considered to be safe and beneficial, at least in terms of PTDM. Tacrolimus as immunosuppressant, recipient, family history of DM and obesity were the risk factors of PTDM development. PTDM was reversible in 28.3% of patients. PTDM had little impact on clinical outcomes during mid-term period.
