Optimal screening for hyperglycemia after kidney transplantation remains uncertain. As plasma glucose peaks 7-8 hours after prednisolone administration, fasting plasma glucose (FPG) and oral glucose tolerance testing (OGTT) may be insensitive early posttransplant. When renal function and hemoglobin stabilise, HbA1c may gain utility.

We compared sensitivity of various methods for detecting posttransplant hyperglycemia. Capillary blood glucose testing (CapBG) was measured during the initial transplant admission. OGTT, FPG, HbA1c and 16:00hrs CapBG were compared at 6 weeks, while OGTT, FPG and HbA1c were compared at 3 and 12 months. Hyperglycemia was defined as CapBG≥200mg/dL, FPG≥126mg/dL, 2hPG≥200mg/dL or HbA1c≥6.5%.

Hyperglycemia was detected in 71% during the initial transplant admission (N=365). At 6 weeks, hyperglycemia was detected in 46% with CapBG versus 12% with OGTT (p=0.013), 4% with HbA1c (p=0.0008) and 0% with FPG (p<0.0001)(N=26)(Figures 1 and 2). At 3 months in 14% with HbA1c versus 20% with OGTT (p=0.60) and 2% with FPG (p=0.054)(N=50). At 12 months in 4% with HbA1c versus 6% with OGTT (p=1.0) and 2% with FPG (p=0.62)(N=51).

These findings suggest that FPG alone is inadequate to detect hyperglycemia within 6 weeks posttransplant, when screening should include1600hrs CapBG. Beyond 3 months HbA1c had similar sensitivity to OGTT and may be an alternative.

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