Impact of Diabetes Mellitus and New Onset Diabetes After Transplant on outcomes after Renal Transplantation — ASN Events
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  3. Impact of Diabetes Mellitus and New Onset Diabetes After Transplant on outcomes after Renal Transplantation

Impact of Diabetes Mellitus and New Onset Diabetes After Transplant on outcomes after Renal Transplantation (#200)

Angela Sheu 1 2 , Beverly Ng 1 , Kathy Fu 3 4 , George Mangos 3 4 , Barbara Depczynski 1 2
  1. Prince of Wales Hospital, Sydney, NSW, Australia
  2. Prince of Wales Clinical School, UNSW, Sydney, NSW, Australia
  3. St George Hospital, Sydney, NSW, Australia
  4. St George & Sutherland Clinical School, UNSW, Sydney, NSW, Australia

BACKGROUND: Patients with pre-existing diabetes mellitus (DM) have increased rates of graft loss and mortality after renal transplantation, therefore understanding the impact of DM and new onset diabetes after transplantation (NODAT) is important in improving patient and graft survival in transplant recipients.

AIM: To determine the perioperative and one-year outcomes after renal transplantation and whether these outcomes are affected by pre-existing DM or NODAT.

METHOD: This is a retrospective chart review of renal transplant recipients at a single centre over 5.5 years. Adult patients were eligible if follow up data was available for, or death occurred within, one year post-transplant. The presence of DM was based on whether it was listed as a pre-transplant comorbidity. NODAT was defined by the treating physician on follow up after transplantation or if management was instituted based on hyperglycaemia.

RESULTS: 148 patients were available for analysis. 29 (19.6%) had DM and 27 (18.2%) developed NODAT. Following transplantation, patients with DM had a longer hospital stay (16.9±9.7 vs 13±5.6 days, p<0.01), more infective complications (34.5% vs 13%, p<0.01), and were more likely to require renal replacement therapy (RRT) (48.3% vs 19.6%, p<0.01) as compared to those without DM. There was no increased rate of acute rejection in DM patients (13.8% vs 7.6%, p=NS). NODAT patients had increased rates of requiring RRT (51.9% vs 19.6%, p<0.01), acute rejection (25.9% vs 7.6%, p<0.05) and any adverse outcome (any complication, RRT or death) (74.1% vs 43.5%, p<0.01). At 1 year post-transplant, patients with DM had more cardiovascular or cerebrovascular complications (20.7% vs 4.3%, p<0.05) compared with those without DM. There were no differences in vascular complications in NODAT patients. At 1 year, mean HbA1c for patients with DM was 7.7%±1.8 (DM vs control, p<0.01), 6.5%±0.7 for patients with NODAT (vs control, p<0.05) and 5.6%±0.6 for controls.

CONCLUSIONS: Compared to patients without DM, patients with DM or NODAT are more likely to suffer from complications during the perioperative period and the first 12 months after renal transplantation. DM and NODAT patients have different outcomes and further prospective studies to characterise these groups may be useful in tailoring post-transplant management.