Risk factors for post-transplant diabetes mellitus in kidney transplant recipients: a single-center retrospective study

Abstract

Aims: Kidney transplantation is one of the preferred treatment modalities in end-stage renal disease (ESRD) and significantly preserves kidney function and the patient's quality of life. However, post-transplant diabetes mellitus (PTDM) is a common complication, occurring in approximately one-third of renal transplant recipients. The main aims of our study were to determine the risk factors associated with the development of PTDM in renal transplant patients, to demonstrate its incidence, and to evaluate its long-term consequences on graft and patient survival. Methods: This single-center retrospective study included 242 non-diabetic kidney transplant recipients who underwent transplantation between January 2014 and December 2022. Patients with pre-existing diabetes, younger than 18 years old, multiple transplants or graft survival of less than one year were excluded. Demographic data, immunosuppressive regimens, perioperative glucose levels and laboratory findings were collected. All patients classified as having PTDM required glucose lowering treatment—either oral antidiabetic agents or insulin—initiated after the third month post-transplant, confirming the persistence of hyperglycemia beyond the early postoperative period. Statistical analysis were performed using IBM SPSS 22 with categorical variables compared using Pearson Chi-square test and continuous variables using Mann-Whitney U test. ROC analysis logistic regression were conducted to identify risk factors for PTDM. Results: PTDM developed more frequently in older (45 vs. 33 years, p<0.001) and higher body-mass index (BMI) recipients (26 vs. 21.7 kg/m², p<0.001). Pretransplant hypertension and coronary artery disease (CAD) were significantly more common in the PTDM group (48.6% vs. 29.3%, p=0.020; 13.5% vs. 2%, p=0.003). ROC analysis identified cutoff values of 36.5 years for age (AUC 0.701) and 24.5 kg/m² for BMI (AUC 0.732) in predicting PTDM. In multivariate logistic regression, independent predictors of PTDM were recipient age, BMI, pretransplant CAD, perioperative glucose level, and duration of renal replacement therapy. Among them, BMI and pretransplant CAD showed the strongest associations (OR 1.205, p<0.001; OR 7.373, p=0.015). Conclusion: The study found a 15.2% incidence of PTDM. Older age, higher BMI, pre-transplant CAD, and elevated perioperative glucose levels were identified as key risk factors. Notably, no significant differences in graft survival or mortality were observed between PTDM and non-PTDM groups, despite PTDM's known adverse effects.

Keywords

• Kidney transplantation
• post-transplant diabetes mellitus
• risk factors
• body mass index
• coronary artery disease

Transplantasyon sonrası diyabet mellitusun greft sağkalımı ve mortalite üzerindeki etkisi: tek merkezli retrospektif kohort çalışması

Abstract

Amaç: Böbrek transplantasyonu, son dönem böbrek hastalığında (SDBH) tercih edilen tedavi yöntemlerinden biri olup, böbrek fonksiyonlarını ve hastanın yaşam kalitesini önemli ölçüde korur. Ancak, post-transplant diyabetes mellitus (PTDM) sık görülen bir komplikasyondur ve böbrek nakli alıcılarının yaklaşık üçte birinde ortaya çıkar. Bu çalışmanın temel amacı, böbrek nakli alıcılarında PTDM gelişimi ile ilişkili risk faktörlerini belirlemek, insidansını göstermek ve uzun dönem greft ile hasta sağkalımı üzerindeki etkilerini değerlendirmektir. Yöntemler: Tek merkezli retrospektif bu çalışmaya Ocak 2014 – Aralık 2022 tarihleri arasında böbrek transplantasyonu yapılan 242 diyabetik olmayan hasta dahil edilmiştir. Önceden diyabeti olan, 18 yaşından küçük, çoklu transplant geçiren veya greft sağkalımı bir yıldan az olan hastalar çalışmaya dahil edilmemiştir. Demografik veriler, immünsüpresif tedavi rejimleri, perioperatif glukoz düzeyleri ve laboratuvar bulguları kayıt edilmiştir. İstatistiksel analizler IBM SPSS 22 programı kullanılarak yapılmış; kategorik değişkenler Pearson Ki-kare testi, sürekli değişkenler Mann-Whitney U testi ile karşılaştırılmıştır. PTDM risk faktörlerini belirlemek için ROC analizi ve lojistik regresyon analizi uygulanmıştır. Bulgular: Çalışmamızda PTDM insidansı %15,2 olarak bulunmuştur. PTDM gelişen hastalar daha yaşlı (45 vs. 33 yıl, p<0,001) ve daha yüksek vücut kitle indeksine (VKİ) sahipti (26 kg/m² vs. 21,7 kg/m², p<0,001). PTDM grubunda pre-transplant hipertansiyon ve koroner arter hastalığı (KAH) daha yaygındı. Çok değişkenli lojistik regresyon analizinde, yüksek VKİ (OR: 1,133, %95 GA: 1,037-1,238, p=0,006), pre-transplant KAH(OR: 5,678, %95 GA: 1,247-25,852, p=0,025) ve yüksek perioperatif glukoz düzeyleri (OR: 1,013, %95 GA: 1,003-1,023, p=0,013) bağımsız PTDM risk faktörleri olarak saptanmıştır. Ortalama 6 yıllık takip süresinde PTDM ve PTDM olmayan gruplar arasında greft sağkalımı veya mortalite açısından anlamlı fark gözlenmemiştir. Sonuç: Çalışmada PTDM insidansı %15,2 olarak belirlenmiştir. Daha ileri yaş, yüksek VKİ, pre-transplant KAH ve yüksek perioperatif glukoz düzeyleri önemli risk faktörleri olarak saptanmıştır. PTDM’nin bilinen olumsuz etkilerine rağmen, PTDM ve PTDM olmayan gruplar arasında greft sağkalımı veya mortalite açısından anlamlı fark bulunmamıştır.

Keywords

• Böbrek nakli
• Nakil Sonrası Diyabetes Mellitus
• Risk Faktörleri
• Greft Sağkalımı
• Ölüm

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