New Onset Diabetes after Renal Transplantation (NODAT): Prevalence, Risk Factors and Treatment

Title: New Onset Diabetes after Renal Transplantation (NODAT): Prevalence, Risk Factors and Treatment

Authors: Lakshminarayana GR, Sheetal LG, Anil M, Rajesh R, George K, Unni VN

DOI: http://dx.doi.org/10.18535/jmscr/v4i1.30

Abstract

References

Corresponding Author

Abstract

Background:This study was conducted to assess the prevalence rate, risk factors and response to treatment of NODAT after renal transplantation.

Methods:All consecutive non-diabetic renal transplant recipients (RTR) from 2005 to 2011; done at AIMS, Kochi, were included in the study. ADA criteria (2003) for NODAT was for its diagnosis.

Results:The study group included 125 (M:101, F:24) RTRs with a mean age of 31.53 years, with a mean follow-up of 32.01 months after surgery. The prevalence rate of NODAT was 23%. Majority (80 %) of recipients with NODAT, had it within first 6 months after surgery. The prevalence rate of NODAT was higher males and those aged >40 years. The prevalence rate of NODAT was higher in those with family history of diabetes mellitus and pre-transplant impaired glucose levels.The prevalence rate of NODAT was higher with Tacrolimus based regimen and also those receiving methyl prednisolone as part of antirejection therapy. Majority (55 %) of those with NODAT had normal BMI. The prevalence of graft dysfunction was higher in those with NODAT.

Conclusions: The prevalence rate of NODAT was 23%, with a peak incidence in initial 6 months after renal transplantation. The non-modifiable risk factors for NODAT were; age > 40 years, male gender, pre-transplant impaired glucose levels and family history of diabetes mellitus. The modifiable risk factors for NODAT were; immunosuppressive drugs (Tacrolimus > Cyclosporine A), antirejection therapy with Methyl prednisolone. The prevalence of graft dysfunction was higher in those with NODAT than those without NODAT.

Key Words: NODAT, Renal transplantation, Modifiable risk factors, non-modifiable risk factors,

References

1. Victor MM, Ananda B, Patricia JE, Jorge AV, Erwin JA, Sherine EG, et al. Post-transplantation Diabetes. A systematic review of the literature. Diabetes Care 2002; 25:583–592.

2. Maskey R. New-Onset Diabetes After Transplant (NODAT). J Diabetes Res Ther 2105, 1(1): DOI: Http:// Dx.Doi.Org/10.16966/2380-5544.105.

3. Marília BG, Roberta AC. Post-Transplant Diabetes Mellitus. Diabetology & Metabolic Syndrome 2009, 1:1-4. DOI:10.1186/1758-5996-1-14.

4. Emilio R, Gema FF, Rosalia V, Juan CR, Celestino P, Rosa P, et al. New-Onset Diabetes After Kidney Transplantation: Risk Factors. J Am SocNephrol 2006; 17: S291–S295. DOI: 10.1681/Asn.2006080929.

5. Mazali FC, Lalli CA, Alves-Filho G, Mazzali M. Post-transplant diabetes mellitus: incidence and risk factors. Transplant Proc. 2008; 40(3):764-766. DOI: 10.1016/j.transproceed.2008.03.018.

6. Gnatta D, Keitel E, Heineck I, Cardoso BD, Rodrigues AP, Michel K, et al. Use of tacrolimus and the development of post-transplant diabetes mellitus: A Brazilian single-center, observational study. Transplant Proc. 2010;42(2):475-478. DOI: 10.1016/j.transproceed.2010.02.021.

7. First MR, Gerber DA, Hariharan S, Kaufman DB, Shapiro R. Post-transplant diabetes mellitus in kidney allograft recipients: incidence, risk factors, and management. Transplantation. 2002; 73(3): 379-386.

8. Fernando GC, Todd EP, Kwame O, Mitchell LH, Ronald MF.Post-Transplant Diabetes Mellitus: Increasing Incidence in RenalAllograft Recipients Transplanted in Recent Years. Kidney International 2001; 59: 732–737.

9. Gourishankar S, Jhangri GS, Tonelli M, Wales LH, Cockfield SM. Development of diabetes mellitus following kidney transplantation: A Canadian experience. Am J Transplant. 2004 Nov;4(11):1876-1882.

10. Jayant TM, Madhumathi R, Victoria J, Selvakumar R, Chakko KJ.Post-Transplant Hyperglycaemia: A Study of Risk Factors. Nephrol Dial Transplant 2003; 18: 164–171.

11. Jai P, Surendra SS, Takhellambam BS, Tauhidul AC, Prabhakar, Usha. New onset diabetes after transplantation (NODAT): Analysis of pre-transplant risk factors in renal allograft recipients. Indian Journal of Transplantation 2012; 6 (3): 77-82. http://dx.doi.org/10.1016/j.ijt.2012.07.003.

12. Agarwal DK, Upendra S. Post-Transplant Diabetes Mellitus in Renal Transplant Recipients. Apollo Medicine 2008; 5 (4): 338–344.xDK Agarwal DOI: http://dx.doi .org/10.1016/S0976-0016(11)60162-2.

13. Saxena S, Dash SC, Guleria S, Mittal R, Agarwal SK, Tiwari SC, et al. Post-transplant diabetes mellitus in live related renal allograft recipients: a single centre experience. J Assoc Physicians India. 1996 Jul;44(7):472, 477-9.

14. Bäckman LA. Post-transplant diabetes mellitus: the last 10 years with tacrolimus.Nephrol Dial Transplant. 2004; 19 (Suppl 6): 13-16.

15. Penfornis A, Kury PS. Immunosuppressive drug-induced diabetes. Diabetes Metab. 2006;32(5):539-546.

16. Jindal RM, Sidner RA. Post-Transplant Diabetes Mellitus. The Role of Immunosuppression. Drug Saf. 1997; 16(4):242-257.

17. Prasad N, Gurjer D, Bhadauria D, Gupta A, Srivastava A, Kaul A, et al. Is Basiliximab induction, a novel risk factor for new onset diabetes after transplantation for living donor renal allograft recipients?Nephrology (Carlton). 2014; 19(4): 244-250. Doi: 10.1111/nep.12209.

18. Johannes P. Van H, Maarten HL, Christiaans, Elly M. Van D. Evaluating Mechanisms of Post-Transplant Diabetes Mellitus. Nephrol Dial Transplant 2004; 19 [S6]: 8–12, Doi:10.1093/Ndt/Gfh1063.

19. Iida S, Ishida H, Tokumoto T, Omoto K, Shirakawa H, Shimizu T, et al. New-onset diabetes after transplantation in tacrolimus-treated, living kidney transplantation: long-term impact and utility of the pre-transplant OGTT. IntUrolNephrol. 2010; 42(4): 935-945. DOI: 10.1007/s11255-010-9712-0.

20. Yogesh NVR, Georgi A, Varun S, Pooja PR, Milly M, Prethivee N, et al. Is There a Genetic Predisposition to New-Onset Diabetes After Kidney Transplantation? Saudi J Kidney Dis Transpl 2015; 26(6): 1113-1120.

21. Shazia A, Kesiraju S and Sumanlatha. Association of Genetic Risk Factors and Underlying Mechanism in the Development of New-Onset Diabetes after Transplantation. Donnish Journal of Genetics and Molecular Biology 2015; 1(2): 06-15.

22. Lidia G, Daniel A, Raymond V, Steven VL, Marc JA. New-Onset Diabetes After Renal Transplantation. Risk Assessment and Management. Diabetes Care 2012; 35: 181-188.

23. Trond J, Anders H. Emerging treatments for post-transplantation diabetes mellitus. Nature Reviews Nephrology. 2015; 11: 465-477. doi:10.1038/nrneph.2015.59

24. Debmalya S, Soumava G, Pratik D. A retrospective study evaluating efficacy and safety of Linagliptin in treatment of NODAT (in renal transplant recipients) in a real world setting. Indian Journal of Endocrinology and Metabolism 2013; 17 (Suppl 1): S203-205.

25. Osama G, Nashwa F, Torki AO, Tarek S. New Onset Diabetes after Transplantation [NODAT] Risks Factors Outcome and Possible Role of Diabetes Educators. J NephrolTher 2014, S1: 005. DOI: http://dx.doi.org/10.4172/2161-0959.S1-005.

26. Davidson J, Wilkinson AH, Dantal J, Dotta F, Heller H, et al. New-onset diabetes after transplantation: 2003 international consensus guidelines. Transplantation. 2003; 7: SS3-SS24.

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Call For Paper Volume 12 Issue 10 November 2024

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