NEW ONSET OF DIABETES MELLITUS IN INDIAN RENAL TRANSPLANT RECIPIENT-A RETROSPECTIVE STUDY

Authors

  • Dharmik D Patel PhD Scholar, School of Pharmacy, R K University, Rajkot
  • Ketan P Modi B K Modi government college
  • Anil K Patel Care Hospital
  • Vipul Chaudhary Government Medical College,

Keywords:

New-onset of diabetes, Immunosuppressant drug, Kidney transplant, Infection, Calciurine inhibitor

Abstract

Objective: To identify incidence and determinant of new-onset of diabetes after transplant (NODAT) in Indian renal transplant recipients.

Methods: In this study Indian renal transplant recipients who were not diabetic before transplant and underwent kidney transplantation between July 2004 and June 2011 were enrolled. Various data of all transplant patients including age, gender, body weight, pre transplant Hepatitis C virus (HCV), Hepatitis B virus (HBV) infection status, Human Leukocyte Antigens (HLA) mismatch, maintenance immunosuppressant drug, usage of antibodies, anti rejection treatment, patients and graft survival, post-transplant infection including HCV, HBV, Herpes and Cytomegalo virus (CMV) infection were noted down. In this study patients who had taken anti diabetic medicine beyond 1 month were considered as diabetic.

Results: Total 537 renal transplant recipients were enrolled in the study. Patients age (P<0.0001), body weight (P=0.042) and HLA mismatch (P=0.015) were significantly effected on prevalence of NODAT. Other parameters like sex (P=0.862), type of donor (P=0.191), pre transplant HBV (P=0.285) and pre transplant HCV (P=0.201) were not significantly affecting development of NODAT. NODAT prevalence was not significantly affected by different Calciurine Inhibitors (CNIs) (P=0.079), antibodies (P=0.671) and by anti rejection therapy (P=0.115). Post-transplant infection was significantly higher in NODAT patients (P=0.022) and mainly among them CMV infection was prevalent (P=0.002). Other infections were found similar in patients with or without NODAT. NODAT was not significantly affecting patients survival (P=0.828) and graft survival (P=0.101).

Conclusion: Age more than 45 years, body weight more than 70 kilogram, HLA mismatch, tacrolimus treatment are significantly affecting development of NODAT in Indian transplant recipients. NODAT is strongly associated with development of post-transplant infection and among them CMV infection was prevalent.

 

Downloads

Download data is not yet available.

References

Aktas A. Transplanted kidney function evaluation. Semin Nucl Med 2014;44:129-45.

D’Addio F, Vergani A, Di Fenza R, Tezza S, Bassi R, Fiorina P. Novel immunological aspects of pediatric kidney transplantation. G Ital Nefrol 2012;29:44-8.

Del Carro U, Fiorina P, Amadio S, De Toni Franceschini L, Petrelli A, Menini S, et al. Evaluation of polyneuropathy markers in type 1 diabetic kidney transplant patients and effects of islet transplantation: neurophysiological and skin biopsy longitudinal analysis. Diabetes Care 2007;30:3063-9.

Ducloux D, Kazory A, Chalopin JM. Post-transplant diabetes mellitus and atherosclerotic events in renal transplant recipients: A prospective study. Transplantation 2005;79:438-43.

Perseghin G, Fiorina P, De Cobelli F, Paola Scifo, Antonio Esposito, Tamara Canu, et al. Cross sectional assessment of the effect of kidney and kidney-pancreas transplantation on resting left ventricular energy metabolism in type 1 diabetic-uremic patients: a phosphorous-31 magnetic resonance spectroscopy study. J Am Coll Cardiol 2005;46:1085-92.

Valderhaug TG, Hjelmesaeth J, Hartmann A, Roislien J, Bergrem HA, Leivestad T, et al. The association of early post-transplant glucose levels with long-term mortality. Diabetologia 2011;54:1341-9.

Fiorina P, Bassi R, Gremizzi C, Vergani A, Caldara R, Mello A, et al. 31Pmagnetic resonance spectroscopy (31P-MRS) detects early changes in kidney high-energy phosphate metabolism during a 6-month Valsartan treatment in diabetic and non-diabetic kidney-transplanted patients. Acta Diabetol 2012;49:133-9.

Fiorina P, Perseghin G, De Cobelli F, Gremizzi C, Petrelli A, Monti L, et al. Altered kidney graft high-energy phosphate metabolism in kidney-transplanted end-stage renal disease type 1 diabetic patients: a cross-sectional analysis of the effect of kidney alone and kidney-pancreas transplantation. Diabetes Care 2007;30:597-603.

Fiorina P, Venturini M, Folli F, Losio C, Maffi P, Placidi C, et al. Natural history of kidney graft survival, hypertrophy, and vascular function in end-stage renal disease type 1 diabetic kidney-transplanted patients: beneficial impact of pancreas and successful islet cotransplantation. Diabetes Care 2005;28:1303-10.

Davidson J, Wilkinson A, Dantal J. New-onset diabetes after transplantation: 2003 International Consensus Guidelines. Transplantation 2003;75:SS3-SS24.

Roth D, Milgrom M, Esquenazi V, Fuller L, Burke G, Miller J. Posttransplant hyperglycemia. Increased incidence in cyclosporine-treated renal allograft recipients. Transplantation 1989;47:278–81.

Araki M, Flechner SM, Ismail HR, Flechner LM, Zhou L, Derweesh IH, et al. Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or m TOR inhibitor drugs. Transplantation 2006;81:335–41.

Montori VM, Basu A, Erwin PJ, Velosa JA, Gabriel SE, Kudva Y. Posttransplantation diabetes. A systematic review of the literature. Diabetes Care 2002;25:583.

Cosio FG, Pesavento TE, Osei K, Henry ML, Ferguson RM. Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001;59:732-7.

Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003;3:178-85.

Wyzgal J, Paczek L, Sanko-Resmer J, Ciszek M, Nowak M, Rowiński W, et al. Insulin resistance in kidney allograft recipients treated with calcineurin inhibitors. Ann Transplant 2007;12:26-9.

Brzezinska B, Junik R, Kaminska A, WÅ‚odarczyk Z, Adamowicz A. Factors associated with glucose metabolism disorder after kidney transplantation. Endokrynol Pol 2013;64:21-5.

Chaoyang Lv, Minling Chen, Ming Xu, Guiping Xu, Yao Zhang, Shunmei He, et al. Influencing factors of new-onset diabetes after a renal transplant and their effects on complications and survival rate. Plos One 2014;9:1-10.

Kaveeshwar SA, Jon Cornwall. The current state of diabetes mellitus in India. Australas Med J 2014;7:45–8.

Cosio FG, Kudva Y, van der Velde M, Larson TS, Textor SC, Griffin MD, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation. Kidney Int 2005;67:2415-21.

Numakura K, Satoh S, Tsuchiya N, Horikawa Y, Inoue T, Kakinuma H, et al. Clinical and genetic risk factors for posttransplant diabetes mellitus in adult renal transplant recipients treated with tacrolimus. Transplantation 2005;80:1419-24.

Boudreaux JP, McHugh L, Canafax DM, Ascher N, Sutherland DE, Payne W, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation 1987;44:376–81.

Allison ME, Wreghitt T, Palmer CR, Alexander GJ. Evidence for a link between hepatitis C virus infection and diabetes mellitus in a cirrhotic population. J Hepatol 1994;21:1135-9.

Grimbert S, Valensi P, Lévy-Marchal C, Perret G, Richardet JP, Raffoux C, et al. High prevalence of diabetes mellitus in patients with chronic hepatitis C. A case-control study. Gastroenterol Clin Biol 1996;20:544-8.

Fabrizi F, Martin P, Dixit V, Bunnapradist S, Kanwal F, Dulai G. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: Meta-analysis of clinical studies. Am J Transplant 2005;5:2433-40.

Shah T, Kasravi A, Huang E, Hayashi R, Young B, Cho YW, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation 2006;82:1673-6.

Kuo HT, Poommipanit N, Sampaio M, Reddy P, Cho YW, Bunnapradist S. Risk factors for development of New-Onset Diabetes Mellitus in pediatric renal transplant recipients: an analysis of the OPTN/UNOS Database. Transplantation 2010;89:434-9.

Hirsch IB, Paauw DS. Diabetes management in special situations. Endocrinol Metab Clin North Am 1997;26:631-45.

Knight Simon R, Morris Peter J. Steroid avoidance or withdrawal after renal transplantation increases the risk of acute rejection but decreases cardiovascular risk. a meta-analysis. Transplantation 2010;89:1-14.

Ghisdal L, Baron C, Le Meur Y, Lionet A, Halimi JM, Rerolle JP, et al. TCF7L2 polymorphism associates with new-onset diabetes after transplantation. J Am Soc Nephrol 2009;20:2459-67.

Maes BD, Kuypers D, Messiaen T, Evenepoel P, Mathieu C, Coosemans W, et al. Posttransplantation diabetes mellitus in FK-506-treated renal transplant recipients: analysis of incidence and risk factors. Transplantation 2001;72:1655-61.

Heit JJ, Apelqvist AA, Gu X, Winslow MM, Neilson JR, Crabtree GR, et al. Calcineurin/NFAT signalling regulates pancreatic betacell growth and function. Nature 2006;443:345-9.

Vincenti F, Friman S, Scheuermann E, Rostaing L, Jenssen T, Campistol JM, et al. DIRECT (Diabetes incidence after renal transplantation: neoral c monitoring versus tacrolimus) Investigators. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant 2007;7:1506-14.

Olaf Heisel, Rochelle Heisel, Robert, Paul Keown. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant 2004;4:583–95.

Webster AC, Woodroffe RC, Taylor RS, Chapman JR, Craig JC. Tacrolimus versus ciclosporin as primary immunosuppression for kidney transplant recipients: meta-analysis and meta-regression of randomised trial data. BMJ 2005;331:8-10.

Tamura K, Fujimura T, Tsutsumi T, Nakamura K, Ogawa T, Atumaru C, et al. Transcriptional inhibition of insulin by FK506 and possible involvement of FK506 binding protein-12 in pancreatic beta-cell. Transplantation 1995;59:1606-13.

Kuo H-T, Sampaio MS, Vincenti F, Bunnapradist S. Associations of pretransplant diabetes mellitus, New-Onset diabetes mellitus after transplant, and acute rejection with transplant outcomes: an analysis of the Organ Procurement and Transplant Network/United network for organ sharing (OPTN/UNOS) database. Am J Kidney Dis 2010;56:1026–8.

Luan FL, Steffick DE, Ojo AO. New-onset diabetes mellitus in kidney transplant recipients discharged on steroid-free immunosuppression. Transplantation 2011;91:334-41.

Neetha S, Biju T, Amita R. Comparison of neutrophil function in diabetic and healthy subjects with chronic generalized periodontitis. J Indian Soc Periodontol 2008;12:41-4.

Published

01-11-2015

How to Cite

Patel, D. D., K. P. Modi, A. K. Patel, and V. Chaudhary. “NEW ONSET OF DIABETES MELLITUS IN INDIAN RENAL TRANSPLANT RECIPIENT-A RETROSPECTIVE STUDY”. International Journal of Pharmacy and Pharmaceutical Sciences, vol. 7, no. 11, Nov. 2015, pp. 228-32, https://innovareacademics.in/journals/index.php/ijpps/article/view/7407.

Issue

Section

Original Article(s)