MON-545 Quality Improvement Intervention for Glycemic Management Post Renal Transplant

Abstract Disclosure: R. Desai: None. J. Lockridge: None. U. Gunasekaran: None. Among renal transplant recipients, diabetes is the most frequently associated clinical condition and 75-92% of all patients regardless of pre-existing diabetes experience hyperglycemia in the first-week post-transplant.1 Early hyperglycemia has been associated with acute graft rejection and worse renal graft function.2 Limited data has been published regarding hyperglycemia in the first year post renal transplant. In this QI project, we aimed to standardize hyperglycemia management for all renal transplant patients by implementing an automatic endocrine consultation while inpatient. Patients were split into two groups to determine their post-hospital follow up timeline: those with immediate graft function (IGF) and those with delayed graft function (DGF) which is defined as requiring HD after transplant. Patients with IGF had a virtual visit 1 week and an in-person visit 3 weeks post-transplant followed by clinic visits every 2 months thereafter. Patients with DGF had a virtual visit 3 days and an in-person visit 10 days post-transplant followed by clinic visits every 2 months thereafter. All patients were taught insulin administration and glucose meter usage while inpatient. We retrospectively reviewed all renal transplant patients between March and December 2023. Patients were excluded from this analysis if they did not have an inpatient diabetes consult or A1c check 6-13 months post-transplant. Our primary endpoint was change in A1c pre-transplant vs. 6-13 months post-transplant. We calculated significance using Welch’s test with a p-value<0.05 considered significant. 46 patients received renal transplants during our study period and of these patients, 25 met our inclusion criteria. 72% of patients had a diagnosis of type 2 diabetes before renal transplant and 64% of patients experienced DGF. The median EGFR at 1-year post-transplant was 53. There was a significant increase in A1c post-transplant for all patients (5.7% ±0.87 vs. 6.9%±1.6, p = 0.002). Patients with diabetes before transplant had a larger average rise in A1c compared to those without diabetes (1.34% ±1.3 vs 0.7% ±1.6, p = 0.38). In addition, patients with DGF had a smaller increase in A1c on average compared to those with IGF (0.81% ±1.2 vs.1.81% ±1.5, p = 0.12). This pattern was present regardless of the presence of diabetes pre-transplant. Overall, patients had a significant increase in their A1c post-transplant despite our QI interventions and although there were differences in the average change of A1c between the DGF and IGF groups and the DM and non-DM groups, these were not statistically significant possibly due to our small sample size. References: 1. Iqbal A et al., JCEM.2022;107(2):549-562. 2. Wyzgal J et al., Ann Transplant. 2007;12(1):40-45. Presentation: Monday, July 14, 2025