Post-transplant diabetes mellitus in kidney transplant recipients: A prospective cohort study of risk factors and clinical outcomes

Post-transplant diabetes mellitus (PTDM) is a common metabolic complication following kidney transplantation and is associated with an increased risk of graft failure, cardiovascular disease, infections, and mortality. We prospectively analyzed the risk factors and clinical consequences of PTDM in patients who underwent kidney transplantation at our center. The study included 130 transplant recipients without preexisting diabetes (79 males, 51 females; mean age: 47.6 years). PTDM was defined as the requirement for pharmacologic treatment at least 3 months after transplantation or based on the oral glucose tolerance test. The observation period ranged from 4 to 75 months. The incidence of PTDM was 21.5% (28/130). Patients who developed PTDM were older (P = .02) and had a higher body mass index (P = .04). Median fasting glucose and HbA1c levels prior to transplantation were significantly higher in patients who later developed PTDM. No significant differences were observed in sex, Charlson Comorbidity Index, dialysis method or duration, number of HLA mismatches, frequency of acute rejection, delayed graft function, reoperation, graft function, steroid dose, or baseline serum levels of insulin, C-peptide, lipid profile, or markers of insulin resistance. Tacrolimus was part of the immunosuppressive regimen in 89% of PTDM patients and 78% of non-PTDM patients (P > .05). In this cohort, general risk factors for diabetes appeared to play a greater role in the development of PTDM than transplantation-specific variables. Simple pre-transplant indicators such as blood glucose and HbA1c may help identify patients at increased risk of PTDM.