New-onset Diabetes Mellitus After Kidney Transplantation-A Paired Kidney Analysis

Background: New-onset diabetes mellitus (NODAT) is a severe complication after kidney transplantation. It is associated with increased risk of graft failure, cardiovascular disease, mortality and infections.

Methods: We retrospectively (partially using the registry database) analyzed risk factors and clinical consequences of NODAT in patients after kidney transplantation performed at the University Transplant Centre between 2001 and 2016. To minimize the donor variability and bias, a paired kidney analysis was applied. Diabetes was defined as the need for insulin therapy for a minimum 30 days after transplantation.

Results: The incidence of NODAT was 7.6% (109 of 1424), but only 74 patients with NODAT had their pairs of patients without NODAT, who received kidneys from the same donor and were included to the analysis. The NODAT group was older, and with a significantly higher Charlson Comorbidity Index (2.97 vs 3.39; P = .02). The groups did not differ significantly with respect to immunosuppressive protocols and number of mismatches (2.65 vs 2.78). The incidence of acute rejection (AR; not biopsy proven) was significantly higher in the NODAT group (30% vs 13%), but the incidence of delayed graft function (DGF) was similar (40%). Creatinine concentration and estimated glomerular filration rate (using the Modified Diet in End-stage Renal Disease equation) 1-month after kidney transplantation did not differ: 1.5 vs 1.54 mg/dL and 49.3 vs 50.2 mL/min, respectively. Body mass index (BMI) was higher in the NODAT group. On multivariate analysis, factors significantly associated with NODAT were: age; AR; Charlson Comorbidity Index; and pretransplant dialysis time. BMI was higher in the NODAT group. NODAT was not a predictor of early graft loss and patient survival in the short-term analysis.

Conclusion: AR, older age, higher comorbidity index, and BMI were risk factors for NODAT. We did not identify an influence of NODAT on early graft function and loss, but further analysis with a longer follow-up is necessary.