Copyright
©The Author(s) 2015.
World J Diabetes. Aug 25, 2015; 6(10): 1132-1151
Published online Aug 25, 2015. doi: 10.4239/wjd.v6.i10.1132
Published online Aug 25, 2015. doi: 10.4239/wjd.v6.i10.1132
Ref. | Criteria | n | Rates |
Cosio et al[3] | Use of medications, F BGL | 490 | 13% at 1 yr |
33% dysglycemic | |||
Hjelmesaeth et al[4] | Use of medications, F BGL, oGTT | 201 | 20% at 3 mo |
Vincenti et al[5] | oGTT | 682 | 30% at 6 mo dysglycemic |
Delgado et al[6] | oGTT, F BGL | 374 | 6.7% at 4.1 yr |
25.1% dysglycemic | |||
Ramesh Prasad et al[7] | F BGL or R BGL | 151 | 20.5% |
Luan et al[8] | oGTT | 203 | 11.8% at 10 wk |
47.8% dysglycemic | |||
Bayer et al[9] | Use of medications, F BGL, R BGL | 640 | 31.4% at 1 yr |
Bergrem et al[10] | Use of medications, F BGL, R BGL | 301 | 13% at 10 wk |
Valderhaug et al[11] | oGTT | 1410 | 17% at 10 wk |
38% dysglycemic | |||
Ciancio et al[12] | Use of medications | 150 | 15%-22% at 4 yr |
Israni et al[13] | Medications, F BGL | 1840 | 13% at 5 yr |
Wauters et al[14] | Use of medications, F BGL | 1146 | 14.1% at 1 mo, 11.1% at 4 mo, 13.4% at 1 yr |
27%, 34.3% and 29.8% dysglycemic | |||
Chan et al[15] | oGTT | 292 | 24% at 6 mo |
Vacher-Coponat et al[16] | Use of medications | 289 | 16.8%-18.8% at 3 yr |
Tillman et al[17] | oGTT | 200 | 5% at 39 mo |
30.5% dysglycemic | |||
Bonet et al[18] | F BGL, R BGL, oGTT | 138 | 13% at 6 mo |
Cole et al[19] | Use of medications, F BGL, oGTT | 49 | 4% at 6 mo |
Nagaraja et al[20] | Use of medications, F BGL | 118 | 21% at 3 mo, 37% at 1 yr |
First et al[21] | Use of medications, F BGL, HbA1c | 634 | 17.8%-36.5% at 1 yr |
Nagaraja et al[22] | oGTT | 76 | 13% at 5 yr, 24% at 11 yr |
42% and 61% dysglycemic | |||
Tokodai et al[23] | Use of medications, F BGL, R BGL | 145 | 11.7% at 1 yr |
Viecelli et al[24] | oGTT | 83 | 17% at 3 mo, 15% at 15 mo |
31% and 21% dysglycemic | |||
Weng et al[25] | Use of medications, F BGL, R BGL | 166 | 29.5% |
Schweer et al[26] | R BGL, HbA1c | 526 | 16.7% |
Prasad et al[27] | oGTT | 439 | 20% at 3 mo |
33% dysglycemic | |||
Silva et al[28] | HbA1c | 638 | 21.3%-41.1% at 4 yr |
Lv et al[29] | F BGL | 428 | 20.3% at 5.7 yr |
Variable | Ref. | Comment |
ATG-divided dose | Stevens et al[48] | Increased dysglycemia compared to single dose in patients treated with Tac and sirolimus |
African American | Kasiske et al[49] Shah et al[50] Johnston et al[51] Bayer et al[9] | OR = 1.68 RR = 1.38 HR = 1.56 HR = 1.35 |
Age | Kasiske et al[49] | Strong independent risk factor |
RR: 1.9-2.6 | ||
Cole et al[52] | 27707 registry patients OR: 1.33 | |
If > 60 yr | ||
Ghisdal et al[53] | OR 1.03 of NODAT for each | |
6 mo of age | ||
Luan et al[8] | Increasing age associated with dysglycemia and new onset metabolic syndrome | |
Luan et al[46] | Analysis of 25837 registry patients, increase in NODAT in each categorised group compared to reference 18-34 years old | |
Israni et al[13] | HR: 1.33 of NODAT at 60 mo | |
Tillmann et al[17] | Increase in dysglycemia at mean of 56 M post-transplant; RR of 1.28 for each 5 yr | |
Mccaughan et al[54] | OR 1.4 per decade in 427 Northern Irish patients | |
Schweer et al[26] | NODAT 56.1 yr vs 47.9 yr; P < 0.01 | |
APCKD | de Mattos et al[55] | Increased 1 yr incidence in a matched cohort |
Hamer et al[56] | Multivariate analysis OR 2.4 | |
Johnston et al[51] | No increase found in 21564 USRDS patients | |
Luan et al[46] | Multivariate analysis OR: 1.17 | |
Ruderman et al[57] | No increased risk found | |
Basiliximab | Aasebø et al[58] | Basilixmab (n = 134) vs no induction historical control; increased dysglycemic state P = 0.017 |
Prasad et al[27] | In living recipients who elected to receive basiliximab OR 2.34 for NODAT at 3 mo | |
BMI | Kasiske et al[49] | Increased BMI, NODAT RR: 1.7 |
Cole et al[52] | Multivariate analysis OR 1.76 for NODAT | |
Luan et al[46] | Analysis of 25837 registry patients. increase in NODAT in each categorised group of BMI compared to reference < 20 | |
Israni et al[13] | BMI ≥ 30, HR 1.69 for NODAT at 60 mo | |
CMV | Hjelmesaeth et al[59] | Asymptomatic infection OR: 4.0 for NODAT at 10 wk |
CNI – | Chan et al[15] | NODAT 17% vs 31%, low dose vs standard dose Tac |
Higher levels | Cole et al[19] | Single arm study of 49 patients with a 4% 6 mo incidence of NODAT. Early glucocorticoid reduction and low dose CsA |
Suszynski et al[60] | Higher Tac levels (plus sirolimus) compared to lower Tac (plus sirolimus) or CsA/MMF higher rates of NODAT with 10 yr FU | |
CNI – | Vincenti et al[5] | RCT. Dysglycemia at 6 mo higher in Tac/MMF vs CsA/MMF: P = 0.05 |
Tac vs CsA | Cole et al[52] | 27707 registry patients OR 1.51 for NODAT |
Luan et al[46] | Analysis of 25837 registry patients. Increase in NODAT OR: 1.24 | |
Vacher-Coponat et al[16] | No difference in CsA/Aza vs Tac/MMF in RCT (n = 289) | |
Cotovio et al[44] | Retrospective multivariate analysis higher Tac not CsA levels associated with NODAT | |
Family history of diabetes | Bora et al[61] | Recipients from living related donors |
Santos et al[62] | Retrospective (n = 303). RR: 3.6 for NODAT | |
Gender | Kasiske et al[49] | Greater risk in males in registry patients |
McCaughan et al[54] | OR 2.2 for male gender in 427 Northern Irish patients | |
Genetic polymorphisms | Ghisdal et al[53] | rs7903146 polymorphism of TCF7L2 OR 1.6 of NODAT at 6 mol/L, but not associated with IGT |
Ghisdal et al[63] | Summarises known associations | |
Kurzawski et al[64] | Polish Caucasian patients. Increasing SNPs associated with increased risk, OR = 1.37 | |
Yao et al[65] | Fok1 vitamin D polymorphism associated with NODAT OR 11.8 P = 0.012 | |
McCaughan et al[54] | 7 SNPs involved with β-cell apoptosis associated with NODAT | |
Nicoletto et al[66] | Adiponectin gene polymorphism associated with NODAT | |
Tavira et al[67] | Mitochondrial haplogroup H associated with NODAT in Tac treated patients | |
Glucocorticoids | Boots et al[68] | Early glucocorticoid withdrawal associated with reduced NODAT incidence in the first year |
Ghisdal et al[53] | OR 2.78 of NODAT at 6 mol/L if AR treated with glucocorticoids | |
Luan et al[46] | Analysis of 25837 registry patients. OR 1.42 for NODAT if discharged on maintenance. Glucocorticoid only induction associated with increase in NODAT OR: 1.31 | |
Rizzari et al[69] | Significant reduction in NODAT compared with historical control when glucocorticoids rapidly tapered | |
Cole et al[19] | Single arm study of 49 patients with a 4% 6 mo incidence of NODAT. Early glucocorticoid reduction and low dose CsA | |
Schweer et al[26] | Pulse glucocorticoid for BPAR associated with increasing NODAT incidence | |
HCV + | Kasiske et al[49] | HCV+, NODAT RR: 1.3 |
Cole et al[52] | 27707 registry patients OR for NODAT 1.82 | |
Johnston et al[51] | 21564 USRDS registry patients, HR: 1.7 for NODAT | |
Baid-Agrawal et al[70] | 14 HCV+ 24 HCV- patients. HCV+ increased insulin resistance; P = 0.008 | |
Luan et al[46] | Analysis of 25837 registry patients. Increase in NODAT OR: 1.43 | |
Lv et al[29] | Cohort of 428 Chinese patients. NODAT associated with HCV at mean 5.6 yr follow up, OR = 2.72 | |
Prasad et al[27] | 439 Indian patients, OR = 6.37 | |
Hyper-parathyroidism post transplant | Ivarsson et al[71] | PTH > 13.8 pmol/L associated with NODAT at 1 yr, OR = 4.25 |
Impaired glycemic state pre-transplant | Ramesh Prasad et al[7] | Higher within the normal range random BSL associated with NODAT |
Bora et al[61] | IGT at time of transplant associated with NODAT | |
Hornum et al[33] | IGT NOT predictive of NODAT | |
Cotovio et al[44] | Higher fasting BGL associated with NODAT | |
Magnesium post-transplant | Garg et al[72] | 1 mol/L lower Mg associated with dysglycemia; no association with 1M CNI trough level |
Magnesium pre-transplant | Augusto et al[73] | Lower magnesium immediately pre-transplant associated with NODAT; P < 0.02 |
Metabolic syndrome post-transplant | Israni et al[13] | MS in first 6-12 mo associated with NODAT by 60 mo, HR = 3.46 |
Luan et al[8] | 10 W dysglycemia associated with MS | |
Nagaraja et al[22] | Development of MS predicts progressive dysglycemia | |
Metabolic syndrome pre-transplant | Bayer et al[9] | HR: 1.34 for NODAT at 1 yr |
Sirolimus | Teutonico et al[74] | No improvement when changing from CNI to sirolimus |
Ekberg et al[75] | Low dose sirolimus may confer less risk than low dose Tac | |
Johnston et al[51] | 20124 registry patients. Compared to CsA + MMF/AZA: Sirolimus + CsA HR 1.61; Sirolimus + Tac HR 1.66; Sirolimus + MMF/AZA HR 1.36 | |
Guerra et al[76] | RCT (n = 150) Tac/sirolimus vs Tac/MMF vs CsA/sirolimus. No difference in NODAT | |
Gyurus et al[77] | Retrospective (n = 514). Sirolimus HR 3.5 for NODAT over 10 yr | |
Veroux et al[78] | 21 NODAT converted to sirolimus, 80% remission of NODAT on basis of F BGL | |
Suszynski et al[60] | Increased risk with high dose Tac/low dose sirolimus combination |
Mortality | CV event/death | Graft loss | Ref. | |
Diabetes at | 3 mo: 37% at 8 yr (HR = 2.1) | 20% (death) at 8 yr (HR = 3.5) | Hjelmesaeth et al[4] | |
10 wk: 34% at 6.7 yr (HR = 2.0) | Valderhaug et al[11] | |||
1 yr: 44% at 11 yr (HR = 2.2) | Death HR: 2.72 | Nagaraja et al[20] | ||
Dysglycemia at | 10 wk: 29% at 6.7 yr (HR = 1.78) each | Events increased with increased F BGL | Cosio et al[3] | |
1 mmol/L oGTT: 5% risk increase | ||||
4 mo: 0.5 mmol/L increase | 1 mmol/L oGTT: 6% risk increase in death | Valderhaug et al[11] | ||
F BGL: 4% risk increase | ||||
12 mo: 0.5 mmol/L increase F BGL: 15% risk increase | 12 mo: 0.5 mmol/L increase F BGL: 11% risk increase for event | Wauters et al[14] | ||
3 mo: RR 3.6 at 6 yr | Wojtusciszyn et al[41] |
- Citation: Langsford D, Dwyer K. Dysglycemia after renal transplantation: Definition, pathogenesis, outcomes and implications for management. World J Diabetes 2015; 6(10): 1132-1151
- URL: https://www.wjgnet.com/1948-9358/full/v6/i10/1132.htm
- DOI: https://dx.doi.org/10.4239/wjd.v6.i10.1132