DOES TIME TO DEVELOP POST- TRANSPLANTATION DIABETES PREDICT TIME TO GRAFT LOSS? AN ANALYSIS OF PATIENTS 20 YEARS POST-KIDNEY TRANSPLANT

Abstract

INTRODUCTION
Post-transplantation diabetes (PTDM) is common after solid organ transplantation. There are data to suggest that this complication may influence the transplant outcomes, namely the risk of graft loss. To analyze whether there is a relationship between age at diagnosis and time to graft loss.

METHODOLOGY
Retrospective study with patients transplanted between 1989-2001 who developed PTDM.

RESULTS
We included 41 patients who had transplantation 24.7 (± 2.4) years ago. Majority (68.3%) were males with a mean age at transplantation of 46.5 (± 11.3) years. The average (years) of diagnosis of DMPT was 4.3 (± 5.3). C-peptide was detectable in all patients. Diabetes autoimmunity was negative in 96.4% of patients, with 1 patient having low anti-GAD65 titers. All patients were treated with therapeutic lifestyle measures, 78.0% were started on insulin therapy (on average 6.5±7.3 years post-transplantation) and 14.6% were started on oral antidiabetics (22.7±6.1 years post-transplantation). The median HbA1c in the 1st 5 years of DMPT was 6.9 ± 1.5%, while the median Hba1c in the 2nd, 3rd, and 4th year was 6.9 ± 1.1% (n = 28), 7,2 ± 1.2% (n = 21) and 6.9 ± 1.1% (n = 12), respectively. To date, 73.2% had graft loss (mean 11.3 ± 6.1 years post-transplant) and 55.3% died (12.2 ± 6.2 years post- transplant). There was a weak but significant correlation between latency to develop DMPT and time to graft loss (r = 0.419, p=0.021).

CONCLUSION
Our study suggests a positive correlation between time to develop PTDM and graft loss. However, it is not possible to establish causality, as earlier appearance of DMPT may be influenced by the doses of immunosuppressants in patients at a greater risk of graft loss.