Multivariable risk of developing new onset diabetes after transplant-results from a single-center study of 481 adult, primary kidney transplant recipients

Gaetano Ciancio, Giselle Guerra, Junichiro Sageshima, Junichiro Sageshima, David Roth, Michael Goldstein, Linda J Chen, Warren Kupin, Adela D Mattiazzi, Lissett Tueros, Sandra Flores, Luis J. Barba, Adrian Lopez, Jose Rivas, Phillip Ruiz, Rodrigo Vianna, George W Burke

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

Background: Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies. Methods: Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre-transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time-dependent covariate) was also tested. Results: Median follow-up was 57 mo post-transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non-white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one-half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m2, non-white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)-the highly elevated NODAT rate observed during the first few months post-transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high-dose (intravenous) corticosteroids. Conclusions: The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.

Original languageEnglish
JournalClinical Transplantation
DOIs
StateAccepted/In press - 2015

Keywords

  • Kidney transplantation
  • Multivariable risk factors
  • New onset diabetes after transplant

ASJC Scopus subject areas

  • Transplantation

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