Introduction:
New onset diabetes after transplant ( NODAT) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of NODAT would help limiting its consequences. This study was conducted to evaluate the incidence , risk factors , tests and effect of immunosuppressant medications and the development of NODAT and its effect on long term graft function and morbidity and mortality.
The diagnosis of PTDM is not easy in a renal failure patient and HBA1C is often unreliable or unpredictable because of unstable HBA1C. The current diagnostic guidelines for NODAT are identical to the diagnostic criteria in DM
· Symptoms of diabetes and random plasma glucose greater than or equal to 200mg/dl (11.1mmol/L)
· Fasting plasma glucose greater than equal to 126mg/dl(7.0mmol/L) which requires repetition on another day.
· Two hour plasma glucose greater than or equal to 200mg/dl (11.1mmol/L) during an oral glucose tolerance test (OGTT).
OGTT is the gold standard for NODAT diagnosis especially in the early stages of transplantation. In this we have focused on the importance of OGTT (oral glucose tolerance test ) in diagnosing occult impaired glucose levels which poses similar cardiovascular risk after few years post transplant. Early detection of NODAT is helpful as it reduces the risks and complications od DM.
Methods:
AIM-
In this study we have studied the modifiable and non modifiable risk factors in development of NODAT in patients undergoing renal transplant at our centre.
OBJECTIVE –
1. To find out the incidence of NODAT
2. To study the risk factors modifiable and non modifiable for NODAT
3. To assess the graft survival and infectious events in follow up period at 1m, 3m, 6m and 12 m post transplant.
MATERIAL AND METHOD
All the renal transplant prospects with no history of diabetes were enrolled in our study. History ( age , race , family history of T2DM), anthropometry ( waist circumference, hip circumference, waist /hip ratio, BMI) , laboratory values for metabolic syndrome( lipid profile, OGTT, fasting glucose) pertaining to risk factor for development of NODAT were taken pre transplant and post transplant doses of immunosuppressant drugs ( total steroid dose , CNI trough levels and doses received , induction agent used ) were correlated with the development of NODAT in post transplant period.
Results:
Prevalence of NODAT in our study population was found to be 35.6%. Out of which 43.5% had their hyperglycemia before 1m follow up suggesting stress hyperglycemia. Mean age was younger in our population 35.84 ±11.96 as compared to previous studies probably because most of study population lied between ages of 20-40 years. Incidence of NODAT was higher in males as compared to females. Despite , no other metabolic parameter had significant correlation with development of NODAT (p value – 0.04) Also Family history of Type2 DM was found to be significant risk factor in development of NODAT.
As suggested in previous large cohorts, OGTT proved to be a valuable test in predicting development of NODAT. As suggested by Porrini et al in 2016 , impaired 1 hr glucose levels predicted about 50% cases of NODAT.
Among transplant related factors , no significant differences were seen in two groups comparing induction agent used, type of donors, relation with donor, CNI trough levels, CNI doses used , total steroid doses given to the patient during hospital stay. No significant relation could be established between episodes of acute rejection due to small numbers. As suggested in previous studies , existence of CMV and HCV infection in patients did not show any significant correlation again probably because of very small sample size.
On follow up for 1year of our study population, rate of infections were 15.3% in NODAT group as compared to 4.2% in Non NODAT group. Major cardiovascular event could not be studied as the follow up was only of 12 months.
Conclusions:
With better understanding of risk factors for NODAT , its incidence can be reduced and thus the risk factors related to it(cardiovascular and infectious events ). OGTT should be regularly performed in all non diabetic recipients to predict high risk population alongwith family history and other metabolic parameters. Distinction should be made between post transplant stress hyperglycemia (upto first 45 days post transplant) and NODAT (persistent hyperglycemia after 45 days). Diligent followup to avoid infections and cardiovascular events , is recommended for patients who develop NODAT .
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.