New-onset diabetes after transplantation in tacrolimus-treated, living kidney transplantation: long-term impact and utility of the pre-transplant OGTT

Abstract

Background: To evaluate the role of the oral glucose tolerance test (OGTT) before transplantation and to examine the risk factors for new-onset diabetes after transplantation (NODAT) during long-term follow-up of renal transplant recipients receiving FK-based therapy.

Methods: The study evaluated 378 patients pre-transplantation using the OGTT and assigned them to one of three groups: Group 1, normal pattern; Group 2, impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) pattern (IFG/IGT); and Group 3, DM pattern.

Results: Although the incidence of NODAT was higher in Group 3 than in groups 1 and 2, no significant difference was found between the three groups with regard to graft survival during long-term follow-up. Multivariate analysis showed that only a family history of diabetes was a significant factor determining NODAT progression.

Conclusions: Impaired glucose tolerance appears to be a threshold influencing NODAT; however, it was not a significant factor in graft survival. Careful monitoring and management based on the result of the pre-transplantation OGTT appear to prevent the deterioration of impaired glucose tolerance in renal transplant recipients receiving FK-based therapy, even when a pre-operative OGTT shows impaired glycemic control.

Fig. 1

Long-term sequential changes in serum creatinine (a), urinary protein (b), fasting blood glucose (c), and blood hemoglobin A1c after transplantation. The mean levels of s-Cr and urinary protein were maintained during the follow-up period in all groups. However, the fasting blood glucose levels in Groups 2 and 3 increased gradually and that of Group 3 was >126 mg/dl for the last 3 years. Although HbA1c levels were higher (>6.5%) for the last 2 years in Group 3, there were no statistically significant differences between the three groups (P > 0.05). Group 1, thin line; Group 2, dotted line; Group 3, thick line; *, statistically significant difference between groups (P < 0.05)

Fig. 2

a Kaplan–Meier estimates of patient survival. All groups demonstrated an excellent patient survival rate throughout the follow-up period. No statistically significant difference was detected between groups (P > 0.05). b Kaplan–Meier estimates of graft survival. Patients who exhibited the DM pattern (Group 3) showed a poorer allograft survival rate 2 years after transplantation (P < 0.05; Group 3 versus Group 1 and 2); however, no statistically significant difference was detected between groups at 5–12 years after transplantation (P > 0.05)