Effect of moderately intense perioperative glucose control on renal allograft function: a pilot randomized controlled trial in renal transplantation

Abstract

Recipient diabetes accounts for ~34% of end-stage renal disease in patients awaiting renal transplantation and has been linked to poor graft function. We conducted a single-center, open-label, randomized controlled trial to determine whether moderately intense glucose control during allograft reperfusion would reduce the incidence of poor graft function. Adult diabetics undergoing deceased donor renal transplant were randomized to moderately intense glucose control (n=30) or standard control (n=30). The primary outcome was poor graft function (dialysis within seven days of transplant or failure of serum creatinine to fall by 10% for three consecutive days). Recipients with moderately intense glucose control had less poor graft function in the intention-to-treat (43.3% vs 73.3%, P=.02) and per-protocol analysis (43.2% vs 81%, P<.01). Recipients with moderately intense control also had higher glomerular filtration rate (GFR) at 30 days after transplant in the per-protocol and intention-to-treat analyses. There were no episodes of severe hypoglycemia in either group and no differences in mortality, seizures, stroke, graft loss, or biopsy-proven rejection. Moderately intense glucose control at the time of allograft reperfusion reduces the incidence of poor graft function in diabetic renal transplant recipients and improves glomerular filtration rate at 30 days.

Trial registration: ClinicalTrials.gov NCT01643382.

Keywords: delayed graft function; diabetes; hyperglycemia; kidney transplantation; poor graft function.

Figure 1.

Flow Diagram for Study Enrollment and Outcomes Participant flow of perioperative glucose control trial.

Figure 2.

Peri-operative Blood Glucose Levels in Kidney Transplant Recipients Abbreviations: MI, moderately intense Box-plot of recipient peri-operative blood glucose levels at multiple time points and divided by treatment group. Each box represents values between the 25^th and 75^th percentile. Whiskers span the 5^th and 95^th percentiles of all data and outliers are represented by dots. Abbreviations: Std, standard glucose control; MI, moderately intense glucose control.