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. 2022 Jun 28;3(10):1738-1745.
doi: 10.34067/KID.0003742022. eCollection 2022 Oct 27.

The Association of Pre-Transplant C-Peptide Level with the Development of Post-Transplant Diabetes: A Cohort Study

Amanda J Vinson  1 , Aran Thanamayooran  1 , Bryce A Kiberd  1 , Kenneth West  1 , Ferhan S Siddiqi  2 , Lakshman Gunaratnam  3   4 , Karthik K Tennankore  1
Affiliations

The Association of Pre-Transplant C-Peptide Level with the Development of Post-Transplant Diabetes: A Cohort Study

Amanda J Vinson et al. Kidney360. .

Abstract

Background: Post-transplant diabetes mellitus (PTDM) is an important complication after kidney transplantation that results in reduced patient and allograft survival. Although there are established risk factors for PTDM, whether pretransplant C-peptide levels associate with PTDM is unknown. Therefore, in this study, we aimed to examine the association of pretransplant C-peptide levels with PTDM.

Methods: This was a cohort study of nondiabetic adult patients who underwent kidney transplant in Nova Scotia, Canada, between January 1, 2016, and March 31, 2021, with fasting C-peptide levels measured before transplant. Multivariable logistic regression was used to determine the association of pretransplant C-peptide (dichotomized around the median) with PTDM at 1 year post transplant. Given the known association between pretransplant obesity and PTDM, we repeated our primary analysis in a cohort restricted to a BMI of 20-35 kg/m2.

Results: The median C-peptide value was 3251 (Q1 2480, Q3 4724); pretransplant C-peptide level was dichotomized at 3000 pmol/L. PTDM occurred in 25 (19%) individuals. Thirty percent of patients in the high and only 2% of patients in the low C-peptide groups developed PTDM (P<0.001). A C-peptide level ≥3000 pmol/L was strongly associated with PTDM in multivariable analysis (OR=18.9, 95% CI, 2.06 to 174.2). In a restricted cohort with a BMI of 20-35 kg/m2, an elevated pretransplant C-peptide remained independently associated with the risk of PTDM (OR=15.7, 95% CI, 1.64 to 150.3). C-peptide was the only factor independently associated with PTDM in this restricted BMI cohort.

Conclusions: A pretransplant C-peptide level ≥3000 pmol/L was associated with a nearly 20-fold increased odds of PTDM at 1 year post kidney transplantation. Identifying patients with high pretransplant C-peptide levels may therefore help identify those at risk for PTDM who may benefit from focused preventative and therapeutic interventions and support.

Keywords: C-peptide; hemoglobin A1c; hyperglycemia; kidney transplantation; nodat; obesity; post-transplant diabetes; risk factors; transplantation.

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Conflict of interest statement

L. Gunaratnam reports consultancy for AstraZeneca Canada, Inc., Novartis Canada Inc., and Paladin Labs, Inc.; honoraria from AstraZeneca Canada, Inc., Novartis Canada Inc., and Paladin Labs Inc.; an advisory or leadership role for AstraZeneca Canada, Inc., Bayer, Inc., and Paladin Labs, Inc.; and participation in a speakers’ bureau for AstraZeneca Canada, Inc. K.K. Tennankore reports consultancy for AstraZeneca, Bayer, GSK, Otsuka, and Vifor; research funding from Otsuka Canada; honoraria from Astra Zeneca, Baxter, GSK, and Otsuka; an advisory or leadership role for the Canadian Journal of Kidney Health and Disease (associate editor); and participating in a speakers’ bureau for AstraZeneca, Baxter, and Bayer. A.J. Vinson reports consultancy for Paladin Labs, Inc., and research funding from Paladin Labs, Inc. K. West reports consultancy for Envarsus Canada, and honoraria from Envarsus Canada. All remaining authors have nothing to disclose.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Histogram of pretransplant fasting C-peptide levels.
See this image and copyright information in PMC

Comment in

References

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