Innovative Trajectory Analysis Reveals Dynamics and Risk Factors of Post-Kidney Transplant Diabetes Mellitus in a French Cohort

Abstract

Background and hypothesis: Post-transplant diabetes mellitus (PTDM) is a common, dynamic complication after kidney transplantation (KT) that may resolve over time. To better understand and prevent PTDM, we analyzed its prevalence, evolution, and influencing factors.

Methods: Data from the French national ASTRE database at different post-transplantation periods (P) were analyzed. PTDM was defined by fasting blood glucose (FBG) ≥1.26 g/L, HbA1c ≥ 6.5%, or the use of hypoglycemic medications in kidney transplant recipients without diabetes. Patient trajectories were identified using group-based trajectory models (GBTM), and associated factors were examined.

Results: Among 2898 patients, PTDM prevalence was 27.3% at P1 (>M2, ≤M6), 21.3% at P2 (>M6, ≤M18), 19.8% at P3 (>M18, ≤M30), and 19.9% at P4 (>M30, ≤M42). Analysis of 1825 patients identified four trajectories: no PTDM (67%), late-onset PTDM (6%), remission after P1 (10%), and early, persistent PTDM (17%). Late-onset PTDM was linked to history of cardiovascular disease, higher BMI at transplantation, HCV positive status, and weight gain. Early, persistent PTDM was associated with older age, higher BMI, HVC positive status, history of cardiovascular disease, and tacrolimus use. PTDM remission was linked to lower BMI. Corticosteroids contributed to both late-onset and persistent PTDM, while switching between tacrolimus and cyclosporine did not significantly affect progression.

Conclusion: This study confirmed the high prevalence and dynamic nature of PTDM after transplantation, emphasizing the critical role of pretransplant cardiovascular disease, BMI, and early post-transplant weight gain in the onset or remission of PTDM.

Keywords: Organ Procurement and Transplantation Network (OPTN); diabetes; kidney disease: metabolic; new onset post‐transplant diabetes; statistics.