Background: New onset diabetes after transplantation (NODAT) adversely impacts both allograft function and patient survival. We hypothesize that higher functional capacity prior to kidney transplant (TX) is protective against development of NODAT.

Methods: We conducted a retrospective study of non-diabetic kidney TX recipients between January 2012 and October 2015 to determine the association of pre-TX functional capacity, measured by peak oxygen uptake (VO_2max) and development of NODAT. In 2012, Mayo Clinic Arizona kidney transplant program incorporated cardiopulmonary exercise testing (CPET) to estimate VO_2max into the CVD screening algorithm among high-risk patients being evaluated for kidney TX. High-risk patients(>50 yrs± history of diabetes, ±history of CVD) underwent VO_2max testing, if VO_2max was <17ml/kg/min) MIBI scan was performed. NODAT was defined by ADA criteria: fasting blood glucose ≥126 gm/dl ± use of diabetes medications.

Results: We studied 93 of 178 kidney TX recipients with documented VO_2max and non-diabetic pre-TX. Mean age = 56±12 years, 54% male, 32% with family history of DM, BMI= 28±5 kg/m[sup2]. 30 patients developed NODAT within 1 year post-TX. We compared characteristics between those who did and did not develop NODAT. Patients with NODAT were older, higher % hispanic (23% vs.6%, p<0.05), higher %black (13% vs. 8%, P<0.05), had higher fasting glucose and triglyceride. Patient BMI, gender, family history of diabetes, total cholesterol and LDL pre-TX were not significantly different between the 2 groups.

41 patients had a VO_2max >17ml/kg/min. Among those only 17% (7 of 41) developed NODAT, and among the 52 patients with VO_2max<17ml/kg/min, 44% (23 of 52) developed NODAT. In logistic regression analyses V0_2max >17ml/kg/min was significantly associated with lower risk of NODAT (OR =0.26, CI =0.10-0.69, P=0.007), this significant association persisted when adjusted for age, gender and BMI.

Conclusion: Higher functional capacity (VO_2max >17ml/kg/min), conferred lower risk of NODAT. Since VO_2max is a risk factor amenable to change (i.e., exercise training), these results suggest that incorporation of exercise training pre-TX could minimize development of NODAT.

CITATION INFORMATION: Qaqish I, Behmen S, Heilman R, Khamash H, Huskey J, Nair S, Chakkera H. Higher Functional Capacity Prior to Kidney Transplant Confers Lower Risk of New Onset Diabetes After Transplantation. Am J Transplant. 2016;16 (suppl 3).

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