Aim: The incidence of new-onset diabetes after kidney transplantation (NODAT) is largely influenced by immunosuppressive drugs. There is some evidence that its incidence is lower with new immunosuppression protocols and with lower doses of immunosuppression. We aimed to compare the incidences of NODAT in 2 different immunosuppression eras and to determine factors influencing the development of NODAT.

Methods: All non-diabetic patients who received a kidney transplant in a single centre between 1997 and 2001 (old era, n=260) were compared with those who received a transplant between 2004 and 2009 (new era, n=382). In the old era, immunosuppression primarily consisted of tacrolimus (starting dose 0.2mg/kg/day, n=140) or ciclosporin (n=93) plus azathioprine or mycophenolate mofetil (MMF). In the new era, tacrolimus (starting dose progressively decreasing from 0.2 to 0.1mg/kg/day) was the sole primary, and MMF the sole secondary agent. Prednisolone was aimed to be stopped by 3 months in the absence of contraindications in both eras. NODAT was diagnosed according to WHO classification. Logistic regression (LR) was used to analyse factors associated with NODAT.

Results: Mean age (45.5±14 vs. 45±14 years, p=0.6), mean BMI at 1-year (26.7 vs. 26.8, p=0.8) and gender distribution (males 66% vs. 64%, p=0.6) were similar in old and new eras respectively. There was no significant difference in the causes of end-stage renal failure. Biopsy-proven acute rejection (including borderline AR) was lower in the new era (38% vs. 28%, p=0.01). The proportion of patients using prednisolone (>5mg/day) at 1-year was similar (46% vs. 46%, p=0.7). The 1-year overall incidence of NODAT was significantly lower in the new era (47/260, 18.0% vs. 44/382, 11.5%, p=0.02). When only tacrolimus-treated patients were analysed in both eras, the incidence of NODAT was significantly lower in the new era (33/140, 24% vs. 41/366, 11%, p=0.001). On LR, factors significantly associated with the development of NODAT by 1-year were: old era [OR 1.87 (1.13-3.08), p=0.01], age per year [OR 1.05 (1.03-1.07), p<0.001], male gender [OR 1.86 (1.04-3.31), p=0.04] and 1-year BMI [OR 1.08 (1.02-1.13), p=0.005].

Discussion: Despite similar demographic characteristics of recipients in both eras, the 1-year incidence of NODAT was lower with newer immunosuppression protocols. Longer-term follow-up is needed to see whether the cumulative incidence of NODAT is also lower with these new protocols.

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