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Diabetes mellitus after kidney transplantation in Japanese patients: The Japan Academic Consortium of Kidney Transplantation study
Author(s) -
Okumi Masayoshi,
Unagami Kohei,
Hirai Toshihito,
Shimizu Tomokazu,
Ishida Hideki,
Tanabe Kazunari
Publication year - 2017
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.13253
Subject(s) - medicine , transplantation , kidney transplantation , diabetes mellitus , kidney , intensive care medicine , endocrinology
Objectives To clarify the incidence rate of post‐transplant diabetes mellitus and associated risk factors in Japanese kidney transplant recipients, and to explore which treatment components are most effective in reducing post‐transplant diabetes mellitus. Methods We analyzed 849 Japanese non‐diabetic adult recipients who had undergone living kidney transplantation and had received tacrolimus‐based immunosuppression from 1996 to 2013 with a median follow‐up of 5 years. Results In all, 127 patients developed post‐transplant diabetes mellitus during the follow‐up period. The incidence rate of post‐transplant diabetes mellitus was 15.1% (95% confidence interval 12.7–17.5) at 5 years. Recipient age (hazard ratio 1.05, 95% confidence interval 1.05–1.06, P < 0.001 for every 5‐year increase), obesity (hazard ratio 1.70, 95% confidence interval 1.06–2.73, P = 0.028), tacrolimus trough level at 2 weeks post‐transplantation (hazard ratio 1.06, 95% confidence interval 1.03–1.09, P < 0.001 for a 1‐ng/mL increase) and mycophenolate mofetil use (hazard ratio 0.46, 95% confidence interval 0.28–0.77, P = 0.003) were significant predictors of post‐transplant diabetes mellitus. Estimated 5‐year predicted incidence rate after adjusting for age and obesity was 9.4% for recipients with a low tacrolimus trough level, and receiving mycophenolate mofetil and 38.4% for recipients with a high tacrolimus trough level and not receiving mycophenolate mofetil. Conclusions Post‐transplant diabetes mellitus is a common complication in Japan, similar to that in other Western countries. The present results show that an appropriate immunosuppressive regimen with a combination of tacrolimus and mycophenolate mofetil can reduce the likelihood of developing post‐transplant diabetes mellitus. Clinical trials are required to confirm these findings.