Insulin Resistance as a Surrogate Marker for Post-Transplantation Diabetes Mellitus
Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil
Meeting: 2019 American Transplant Congress
Abstract number: C213
Keywords: Dyslipidemia, Hyperglycemia, Post-transplant diabetes, Risk factors
Session Information
Session Name: Poster Session C: Kidney: Cardiovascular and Metabolic
Session Type: Poster Session
Date: Monday, June 3, 2019
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Post-transplantation diabetes mellitus (PTDM) adversely impact patient and kidney allograft survival. Further knowledge of the risk factors involved in the onset and progression of PTDM is needed for not only avoid its occurrence but also to perform and early diagnosis, which ultimately may provide a better care to patients.
*Methods: Modifiable and non-modifiable variables were evaluated and tested for the risk of PTDM in patients who underwent a kidney transplant and were followed for three years. Immunosuppressive regimen was mainly based on tacrolimus (85%), prednisone (100%) and mycophenolate (53%). Azathioprine and imTOR were used in 41.4% and 10.5% of the recipients, respectively.
*Results: In our population, 60% were male, 47% were black, and 57% received a kidney from a deceased donor. Fifty-eight (13.7%) out of 423 recipients developed PTDM. We found that the risk factors for PTDM were: receptor age (45.9±1.3 vs 40.3±0.6 yrs-old;P=0.0006); pre-transplant hyperglycaemia (P=0.026); BMI 25-29.9kg/m2 (41.4% vs 21.4%;P=0.002) or BMI >30kg/m2 (17.2% vs 6.4%;P=0.0062), but not weight gain. Other variables associated with PTDM comprised kidney allograft rejection (44.8% vs 31%;P=0.049); transitory hyperglycaemia, defined as any fasting plasma glucose greater than 110 mg/dL diagnosed in a routine exam between month 1 and 3 after transplant (86% vs 19%;P<0.0001); use of calcium channel blocker (71% vs 55%;P=0.031); and TG/HDL ratio greater than 6 (59% vs 27%;P<0.0001). Conversely, immunosuppressive regimen, including steroid dose adjusted to body weight, race, gender, and hypertension were not related to PTDM. eGFR was not affected in PTDM and non-PTDM groups (58.2±2.8 vs 58.8±1.0 ml/min/1.73m2, respectively) at 3 years.
*Conclusions: Risk factors associated with an increase in insulin resistance, such as, overweight, obesity, pre-transplant hyperglycaemia, and transitory hyperglycaemia may be helpful for risk-stratifying patients to determine appropriate risk-reduction strategies for PTDM. High levels of TG/HDL ratio is a surrogate marker for insulin resistance and ultimately to PTDM.
To cite this abstract in AMA style:
Lucena DDde, Rangel ÉB, Sá JRde, Medina-Pestana JO. Insulin Resistance as a Surrogate Marker for Post-Transplantation Diabetes Mellitus [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/insulin-resistance-as-a-surrogate-marker-for-post-transplantation-diabetes-mellitus/. Accessed November 21, 2024.« Back to 2019 American Transplant Congress