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Kidney transplantation (KT) is associated with an increased risk of post-transplant diabetes mellitus (PTDM), which potentially impacts recipient and graft survival. The incidence of PTDM ranges from 15% to 30%, mainly occurring during the first year post-transplant. This study aimed to analyze the prevalence of PTDM and associated risk factors among renal transplant recipients.
Retrospective single-center study including KT recipients older than 18 years with a functioning graft over six months of follow-up between January and December 2018. Exclusion criteria: recipients younger than 18 years at KT, previous diabetes mellitus diagnosis, and death with a functioning graft or graft failure in the six months post-transplant. For analysis, recipients were divided into two groups, according to the PTDM diagnosis: PTDM and non-PTDM.
From 117 kidney transplants performed during the period, 71 (60.7%) fulfilled the inclusion criteria. Most of the included patients were male (n=42, 59.1%), with a mean age of 46.3 ± 11.7 years old. All the included patients received a kidney from a deceased donor, with a mean age of 42.3 ± 12.0 years and a mean serum creatinine of 1.73 ± 1.77 mg/dL. Eighteen (25.3%) patients developed PTDM, most (n=16, 88.9%) during the first year post-transplant. The general characteristics were similar between the groups. The need for insulin therapy during the hospital stay was significantly higher in the PTDM group than in the Non-PTDM group (n=11, 61.1% vs. n=14, 26.4%, respectively). Other factors for PTDM, such as older age, high body mass index, HLA mismatches, and cytomegalovirus or hepatitis C virus infections, were not associated with PTDM in this series. At 5-year follow-up, the graft function remained stable in both groups, without significant differences in serum creatinine or urine protein-to-creatinine ratio compared to the initial values. There were five cases of death with a functioning graft (PTDM=1, 5.5% vs. Non-PTDM=4, 7.5%, p=0.99). The incidence of graft failure was similar between the groups (PTDM=2, 11.1% vs. Non-PTDM=4, 7.5%, p=0.63).
The accumulated incidence of PTDM in this series was like those reported in other studies. The need for insulin treatment before hospital discharge was associated with PTDM.