Risk Factors and Outcomes of Post-Transplant Diabetes Mellitus in Renal Transplant Recipients: A 10-Year Retrospective Study

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Abstract Title *

Risk Factors and Outcomes of Post-Transplant Diabetes Mellitus in Renal Transplant Recipients: A 10-Year Retrospective Study

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Co-author 1

Namrata Pareek namzforu@gmail.com Kasturba medical college,Manipal academy of higher education Nephrology Manipal India *

Co-author 2

Shankar Prasad Nagaraju shankar.prasad@manipal.edu Kasturba medical college, Manipal,Manipal academy of higher education Nephrology Manipal India -

Co-author 3

Attur Ravindra Prabhu ravindra.prabhu@manipal.edu Kasturba medical college , Manipal,Manipal academy of higher education Nephrology Manipal India -

Co-author 4

Dharshan Rangaswamy dharshan.r@manipal.edu Kasturba medical college, Manipal,Manipal academy of higher education Nephrology Manipal India -

Co-author 5

Indu Ramchandra Rao indu.rao@manipal.edu Kasturba medical college, Manipal,Manipal academy of higher education Nephrology Manipal India -

Co-author 6

Shrinivas Vinayak Shenoy shenoy.shrinivas@manipal.edu Kasturba medical college, Mainpal,Manipal academy of higher education Nephrology Manipal India -

Co-author 7

Mohan Varadanayakanahalli Bhojaraja mohan.vb@manipal.edu Kasturba medical college, Manipal, Manipal academy of higher education Nephrology Manipal India -

Co-author 8

Divija Sharma divija.sharma07@gmail.com Kasturba medical college, Manipal, Manipal academy of higher education Nephrology Manipal India -

Co-author 9

Tanvi Jain tanvijain0711@gmail.com Kasturba medical college, Manipal, Manipal academy of higher education Nephrology Manipal India -

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Post-transplant diabetes mellitus (PTDM) is a frequent metabolic complication following kidney transplantation, contributing to higher cardiovascular risk, infection rates, and potential graft dysfunction. Understanding its determinants is essential for optimizing patient outcomes. This study aimed to evaluate the clinical profile, risk factors, and outcomes of PTDM among renal transplant recipients over a ten-year period at a tertiary-care center.

Methods

This retrospective observational study analyzed 184 renal transplant recipients who underwent transplantation between January 2013 and December 2023 at Kasturba Medical College, Manipal. PTDM was diagnosed in accordance with the 2014 International Consensus Guidelines. Demographic, clinical, and biochemical parameters were extracted from hospital records. Post-transplant infections, cytomegalovirus (CMV) status, graft function, and mortality were compared between patients with and without PTDM. Univariate and multivariate logistic regression analyses identified independent predictors of PTDM.

Results

PTDM occurred in 32.6 % of recipients (n = 60). Mean age was similar between PTDM and non-PTDM groups (31.5 ± 9.25 years vs. 36.6 ± 10.08 years; p = 0.39), with male predominance in both (81.7 % vs. 81 %). Post-transplant infections were significantly higher in PTDM patients (48.3 % vs. 31.4 %; p = 0.01), as was CMV infection (13.3 % vs. 6.45 %; p = 0.03). On multivariate analysis, CMV infection remained an independent predictor of PTDM (Odds Ratio 4.52, 95 % CI 1.32–15.49; p = 0.01). Graft outcomes, including serum creatinine (p = 0.82) and eGFR (p = 0.16) at one year, did not differ significantly. Mortality rates were comparable between groups (p = 0.51).

Conclusion

PTDM developed in approximately one-third of kidney transplant recipients. CMV infection emerged as a significant independent risk factor, and PTDM was associated with higher post-transplant infection rates. Despite these complications, short-term graft function and mortality were unaffected. Early detection and management of modifiable risks, particularly CMV infection, are crucial to improving metabolic and transplant outcomes in this population

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