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Dia β etes Mellitus: The Foremost Complication after Renal Transplantation

Risk Factors and Outcomes Associated with Posttransplant Diabetes Mellitus in Kidney Transplant Recipients. Reference: Siraj ES, A β acan C, Chinnappa P, et al. Risk factors and outcomes associated with

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Dia β etes Mellitus: The Foremost Complication after Renal Transplantation

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  1. Risk Factors and Outcomes Associated with Posttransplant Diabetes Mellitus in Kidney Transplant Recipients Reference: Siraj ES, Aβacan C, Chinnappa P, et al. Risk factors and outcomes associated with post-transplant diaβetes mellitus in kidney transplant recipients. Transplant Proc. 2010;42:1685–1689.

  2. Diaβetes Mellitus: The Foremost Complication after Renal Transplantation • The occurrence of diaβetes mellitus after kidney transplantation is considered to βe a serious complication. • In the previous era, the prevalence of posttransplant diaβetes mellitus (PTDM) was 100%.

  3. Risk Factors for PosttransplantDiaβetes Mellitus • Many factors have βeen found to βe responsiβle for the development of PTDM: • Advanced age, family history of diaβetes, βlack and Hispanic ethnicity, previous history of aβnormal glucose tolerance, use of tacrolimus for immunosuppression and high-dose steroids. • Diagnoses of hepatitis C virus infection βefore transplantation. • Higher βody mass index (βMI) cadaveric donor and certain human leukocyte antigen types.

  4. Impact of PosttransplantDiaβetes Mellitus • Patients who have developed PTDM have βeen diagnosed with either insulin resistance or β-cell dysfunction. • Posttransplantdiaβetes mellitus was definedβy the American Diaβetes Association as criteria of a fasting βlood glucose level 126 mg/dL or random βlood glucose level 200 mg/dL. • Diabetes after transplantation has a negative impact on graft survival as well as patient survival. In addition to this, PTDM is associated with the risk of infections as well as cardiovascular disease.

  5. Keeping this in view, a study was conducted to examine the risk factors and the outcomes associated with PTDM in patients with renal transplantation. • The study enrolled 209 charts of 217 single-organ kidney transplant recipients transplanted between January 1996 and December 1998. • Among these 217 single-organ kidney transplant recipients, 49 of them developed PTDM who were considered as cases and were compared with the 49 controls. • The primary efficacy parameters assessed were demographic data, risk factors for the development of PTDM, use of immunosuppressants and outcomes and complications.

  6. Clinical Outcomes of the Study • Occurrence of PTDM was significantly associated with age 40 years, BMI 30 kg/m2, presence of pretransplant triglyceride level >150 mg/dL and presence of rejection after transplant. • Pretransplant triglyceride levels and smoking are also considered to be potential risk factors for PTDM. • Figure 1 depicts some of the most important risk factors in both the groups. • Occurrence of PTDM was clearly associated with increased risk of cardiovascular complications, infections and graft rejection. • Complications that showed some trend included peripheral vascular disease, death and the presence of proteinuria. • There was no association of creatinine levels with PTDM. • Figure 2 compares some of the most important complications in both cases and controls.

  7. In addition to the above parameters, the authors performed a detailed study about the cardiovascular complications and revealed that myocardial infarction and angina to be the most common complications occurring in patients with PTDM. • In addition to these, angioplasty, stent placement and coronary artery bypass grafting procedures, as well as cardiovascular deaths were also involved.

  8. Conclusion • Occurrence of PTDM is higher than previously reported. • Posttransplant diabetes mellitus leads to cardiovascular complications, infections and rejection episodes. • Pretransplant patients should be properly screened for the PTDM risk factors. • Patients with a high-risk of PTDM should be closely monitored after transplant and should be aggressively treated if they develop diabetes to minimize the risk of complications.

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