New-onset diabetes after kidney transplantation: Can the risk be modified by choosing immunosuppression regimen based on pretransplant viral serology?

Abstract

Background. This study aimed to analyze adult kidney transplant recipients (KTRs) for the risk of new-onset diabetes after transplantation (NODAT) associated with viral serologies and immunosuppression regimens [tacrolimus (Tac) mycophenolate (MPA), cyclosporine (CSA) MPA, sirolimus (SRL)MPA, SRLCSA or SRLTac]. Methods. Cox regression models were used to examine the risk of NODAT in the first posttransplant year associated with: (i) CSAMPA, SRLMPA, SRLMPA or SRLTac versus reference, TacMPA; (ii) pretransplant viral serology [ or ; hepatitis B core (HBc), hepatitis C (HCV), cytomegalovirus (CMV) or Epstein Barr Virus (EBV)]; and (iii) interactions between immunosuppression regimens and the viral serology found significant in the main analysis. Results. Adult KTRs (n97 644) from January 1995 through September 2015 were studied. HCV[hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.31-1.68] or CMV(HR 1.12, 95% CI 1.06-1.19) serology was a risk factor and HBc(HR 1.04, 95% CI 0.95-1.15) or EBV(HR 1.06, 95% CI 0.97-1.15) serology was not a risk factor for NODAT. Regardless of associated HCV or CMV serology, risk of NODAT relative to the reference regimen (TacMPA) was lower with CSAMPA [HCV: HR 0.74, 95% CI 0.65-0.85; HCV: HR 0.47, 95% CI 0.28-0.78; CMV: CSAMPA HR 0.68, 95% CI 0.54-0.86; CMV: (CSAMPA) HR 0.73, 95% CI 0.63-0.85] and similar with SRLCSA or SRLMPA. In KTRs with HCV or CMV serology, SRLTac was associated with a higher risk of NODAT relative to reference [HCV (HR 1.43, 95% CI 1.17-1.74) and CMV (HR 1.44, 95% CI 1.14-1.81), respectively]. The risk for NODAT-free graft loss was lower with TacMPA than the other regimens. Conclusions. Tailoring immunosuppression regimen based on HCV or CMV serology may modify the risk of developing NODAT in KTRs.