Background:

NODAT in kidney transplant recipients has been associated with graft failure, infection, cardiovascular disease and death.  Predicting those at risk may allow earlier diagnosis, potentially improving outcomes.

Aim:

To examine whether previously described risk factors for type 2 diabetes or transplant specific factors were associated with increased rates of NODAT within 12 months of renal transplant in our cohort.

Methods:

We performed a retrospective review of patients who underwent kidney transplantation at a single centre from January 2009 until June 2014. Eligible patients were adults without pre-existing diabetes with at least one year of follow-up data available. The following risk factors were assessed: Age, sex, BMI, ethnicity, pre-existing hepatitis C, polycystic kidney disease (PKD) versus other kidney disease, prior transplant, donor/recipient CMV antibody status, deceased versus living donor, HLA mismatch, immunosuppressive regimen, plasma triglycerides & HDL pre-transplant, statin use, blood glucose level (BGL) post transplant, delayed graft function and acute rejection (AR) during admission.

Results:

Of 119 eligible participants, 27 (22.7%) were diagnosed with NODAT within 12 months of transplantation. Patients who developed NODAT were older (55±8 versus 47±13 years, p<0.01), were more likely to have PKD (19.2% versus 46.7%, p<0.05), were more likely to have a deceased donor (29% versus 6.1%, p<0.01), had higher triglycerides (2.6±2.1 versus 1.7±0.8 mmol/L, p<0.05), were more likely to be prescribed a statin (36.1 versus 15.4 %, p< 0.05), had higher fasting and maximum day 5 post-transplant BGL (fasting BGL 6.1±1.6 versus 5±1.2 mmol/L, p<0.05; maximum BGL 11±3 versus 8.2±1.7 mmol/L, p<0.01), were more likely to have had delayed graft function (43.5% vs14.5%, p<0.01) and had higher rates of AR (50% versus 23.5%, p<0.01).

Conclusion:

Our findings suggest that patients at risk for NODAT may be able to be identified during their initial hospital admission. It may be worth assessing transplant recipients for these risks and for those identified, adhering to a more rigorous screening program. A prospective study to evaluate these high-risk patients, particularly to assess a possible causal relationship between AR and statins and the development of NODAT, may be appropriate.