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Pediatric Nephrology

, Volume 17, Issue 1, pp 1–5 | Cite as

Increased incidence in post-transplant diabetes mellitus in children: a case-control analysis

  • L. C. Greenspan
  • S. E. Gitelman
  • M. A. Leung
  • D. V. Glidden
  • R. S. Mathias
Transplantation / Original Article

Abstract.

There is limited information regarding the incidence and features of post-transplant diabetes mellitus (PTDM) in pediatric renal transplant recipients. We noted a recent increased frequency of PTDM and reviewed charts of children who underwent renal transplantation from 1 September 1986 to 31 August 1999 to characterize the risk factors and natural history of PTDM. Sixteen children were identified with PTDM, and were each matched with two transplanted controls who did not develop PTDM. Clinical presentation varied from asymptomatic hyperglycemia to hyperosmolar dehydration or diabetic ketoacidosis. The mean time from transplantation to PTDM presentation was 1.2 years (range 1 day to 6.2 years). Significant risk factors for PTDM included: first degree family history of type 2 DM [odds ratio (OR) 23.9]; second degree family history of type 2 DM (OR 5.8); tacrolimus use (OR 9.1 versus cyclosporin); and hyperglycemia in the 2 weeks immediately after transplantation (OR 4.7). Seven of eight children with persistent PTDM continue to receive insulin. Patients with persistent PTDM had later onset disease (mean 1.9 years) compared to those with transient PTDM (0.3 years), suggesting different pathophysiologic processes. We suggest that all children undergoing renal transplantation be screened routinely for PTDM after transplantation, and that such patients may benefit from the avoidance of tacrolimus, as it may cause permanent beta-cell injury.

Keywords Post-transplant diabetes mellitus Pediatrics Tacrolimus Cyclosporin A Beta-cell Renal transplantation 

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Copyright information

© IPNA - International Pediatric Nephrology Association New York, USA 2002

Authors and Affiliations

  • L. C. Greenspan
    • 1
  • S. E. Gitelman
    • 1
  • M. A. Leung
    • 1
  • D. V. Glidden
    • 2
  • R. S. Mathias
    • 3
  1. 1.Division of Endocrinology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143-0434, USA. Lgreens@itsa.ucsf.eduUS
  2. 2.Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143-0434, USAUS
  3. 3.Division of Nephrology, Department of Pediatrics, University of California, San Francisco, San Francisco, CA 94143-0434, USAUS

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