Background: The incidence of new-onset diabetes after kidney transplantation (NODAT) in the pediatric population has not been well characterized. Early recognition of glucose intolerance may allow for interventions and prevention of NODAT development.

Methods: A retrospective, single-center review of hemoglobin A1C (HbA1C) values between 2015 and 2017 were examined for pediatric kidney transplant recipients who were >3 months post-transplant in an effort to identify those as risk for developing NODAT. Multi-organ transplant recipients and known diabetic patients were excluded. All patients received basiliximab and methylprednisolone for induction at the time of transplant and were maintained on a steroid-based immunosuppressive regimen.

Results: A total of 171 patients were reviewed. Of these, 43 (25.1%) patients had HbA1C in the pre-diabetic range (5.7-6.4%) and 1 patient had HbA1C in the diabetic range (>6.5%). Abnormal HbA1C was found in 32/130 (24%) patients maintained on tacrolimus vs. 11/37 (29%) of patients maintained on a sirolimus–based regimen, which was not statistically significantly different. Age, BMI, sex, and use of growth hormone were not significantly different in those with elevated HbA1C as compared to the patients with normal HbA1C. African-American kidney transplant recipients were found to have statistically significantly higher incidence of elevated HbA1C in the pre-diabetic range (52.4% vs. 24.4%; p = 0.002). Of the 44 patients with abnormal HbA1C, 2 patients underwent oral glucose tolerance testing (OGTT) with 1 patient having an abnormal result. The average time from transplant to the first abnormal HbA1C in our cohort was 5.5 years (range: 0.3-14.4 years).

Conclusion: Abnormal HbA1C is common in pediatric kidney transplant recipients. Time from transplant to the development of abnormal HbA1C results may vary greatly. Future efforts at our center will focus on developing standardized screening for glucose intolerance with HbA1C and confirmatory testing using OGTT at certain intervals post-transplant. We will also study effects of anemia and hemoglobin level on accuracy of HbA1C results post-transplant.

CITATION INFORMATION: Serluco A., Liverman R., George R., Garro R. Prevalence of Abnormal Hemoglobin A1C in Pediatric Kidney Transplant Recipients Am J Transplant. 2017;17 (suppl 3).

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