Incidence and Risk Factors Associated with the Development of Hypoglycemia After Combined Pancreas-Kidney Transplantation
1Montefiore Medical Center, New York, NY, 2Montefiore Medical Center, Scarsdale, NY, 3Montefiore Medical Center, Bronx, NY, 4Albert Einstein College of Medicine, Montefiore Medical Ctr, Bronx, NY
Meeting: 2022 American Transplant Congress
Abstract number: 1171
Keywords: Adverse effects, Pancreas
Topic: Clinical Science » Pancreas » 65 - Pancreas and Islet: All Topics
Session Information
Session Name: Pancreas and Islet: All Topics
Session Type: Poster Abstract
Date: Sunday, June 5, 2022
Session Time: 7:00pm-8:00pm
Presentation Time: 7:00pm-8:00pm
Location: Hynes Halls C & D
*Purpose: To review the incidence of hypoglycemia after pancreas transplantation in recipients with type 1 and 2 diabetes mellitus and the risk factors associated with it.
*Methods: This is a single center retrospective study involving recipients >18y who underwent simultaneous pancreas- kidney transplantation between September 2014 and July 2021. Hypoglycemia was defined as random plasma blood glucose level <55, with or without symptoms.
*Results: 102 patients were included in our study – 56 patients (55%) had type 1 DM and 46 patients (45%) had type 2. The mean age was 42 ±10 and 60.8% were male. 50 patients (49%) were Hispanic and 36 (35.3%) were Black. The mean BMI was 26 ±3.7. 33 patients (34%) developed at least one episode of post-transplant at a mean of 4.8 ± 7 months post-transplant. Of these, 17 patients had T1DM (51.5%) and 16 patients (48.5%) had T2DM. 16 of them had recurrent hypoglycemia with a mean number of episodes of 4.6 ±2.9. The mean eGFR at the time of hypoglycemia was 82.2 ±29 ml/min and the mean blood sugar was 45 ±9.4. The symptoms reported were diaphoresis in 3 patients, lethargy in 2 patients, and confusion in 1 patient. There were 2 deaths in the hypoglycemic group and no deaths in the normoglycemic group at a median follow up of 2 (0.91-3.4) years (p=0.1). One patient died from sepsis 20 months post-transplant and the other from cardiovascular disease 75 months post-transplant. The mean daily insulin requirement pre-transplant (U/day) was 28.5 ±17.4 in the hypoglycemic group compared to 38.3 ± 23 in the normoglycemic group. There was no significant difference in terms of gender, race, age, pre-transplant BMI, and pre-transplant C-peptide between both groups. The mean pre-transplant Hemoglobin A1c was 8.1 ± 1.6. 17 patients in our cohort had a pre-transplant HbA1c of < 6.5. We found that the Odds Ratio for developing post-transplant hypoglycemia amongst these patients compared to patients with pre-transplant A1c > 6.5 was 4.05 (95% CI: 1.2 to 13.3, p value- 0.009) when adjusted for pre-transplant BMI and pre-transplant total daily insulin use.
*Conclusions: In our study, post pancreas transplant hypoglycemia occurred in 34% of our patients during a median 2 year follow up period. A pre-transplant HbA1c of < 6.5% was associated with a four times greater risk of developing post-transplant hypoglycemia. There was no relation to age, renal impairment, or pre-transplant insulin requirements.
To cite this abstract in AMA style:
Kapoor S, Jain S, Stefan S, Azzi Y, Ajaimy M, Loarte-Campos P, Pynadath C, Yaffe HC, Le M, Rocca J, Greenstein S, Kinkhabwala M, Graham J, Akalin E, Liriano-Ward L. Incidence and Risk Factors Associated with the Development of Hypoglycemia After Combined Pancreas-Kidney Transplantation [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/incidence-and-risk-factors-associated-with-the-development-of-hypoglycemia-after-combined-pancreas-kidney-transplantation/. Accessed November 21, 2024.« Back to 2022 American Transplant Congress