New-onset diabetes mellitus after renal transplantation

Abstract

Aims. To determine: (i) the incidence of new-onset diabetes mellitus in patients after renal transplantation (NODM); and (ii) the association between NODM and (a) various immunosuppressive regimens, and (b) ethnicity; and (iii) to assess outcomes in terms of morbidity and mortality associated with NODM, i.e. infections, cardiovascular disease, graft function and survival, and overall patient survival. Study design. A retrospective analysis of 398 patient files from Johannesburg Hospital for the transplant period 1 July 1994 to 30 June 2004 was conducted. Information regarding patient age, race, date of onset of diabetes, immunosuppressive regimen, infections, and cardiovascular and overall morbidity and mortality was recorded. Results. Of the patients 15.6% became diabetic (62/398) with a mean time to onset of 22.9 months; 20.2% of black patients (p=0.100), 12.5% of coloured (mixed race) patients, 12.0% of Indian patients and 9.4% of white patients developed NODM. Treatment with cyclosporin A was associated with a 14.4% incidence of diabetes, tacrolimus with an incidence of 20.3% (p=0.228), sirolimus with an incidence of 11.4% and mycophenolate mofetil with an incidence of 12.0%. The patients with diabetes had an infection rate of 96.8% (p<0.0001), cardiovascular mortality of 11.3% (p=0.824) and overall mortality of 26.3%. Conclusions. The incidence of NODM after transplantation is significant, and the condition confers an increased risk of infections and overall mortality. While black patients are most commonly affected, with the greatest risk among those treated with tacrolimus, this did not reach significance, probably owing to the small numbers.