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Multivariable risk of developing new onset diabetes after transplant—results from a single‐center study of 481 adult, primary kidney transplant recipients
Author(s) -
Gaynor Jeffrey J.,
Ciancio Gaetano,
Guerra Giselle,
Sageshima Junichiro,
Hanson Lois,
Roth David,
Goldstein Michael J.,
Chen Linda,
Kupin Warren,
Mattiazzi Adela,
Tueros Lissett,
Flores Sandra,
Barba Luis J.,
Lopez Adrian,
Rivas Jose,
Ruiz Phillip,
Vianna Rodrigo,
Burke George W.
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12510
Subject(s) - medicine , hazard ratio , proportional hazards model , diabetes mellitus , kidney transplant , cohort , single center , transplantation , demography , kidney transplantation , confidence interval , endocrinology , sociology
Abstract Background Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies. Methods Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre‐transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time‐dependent covariate) was also tested. Results Median follow‐up was 57 mo post‐transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.1), planned maintenance with SRL (p = 0.0003), non‐white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one‐half of the 106 patients in the highest demographic risk category ( BMI ≥25 kg/m 2 , non‐white race, and age at transplant ≥40 yr) developed NODAT ; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)—the highly elevated NODAT rate observed during the first few months post‐transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high‐dose (intravenous) corticosteroids. Conclusions The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.