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Risk factors and long-term consequences of new-onset diabetes after renal transplantation

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Irish Journal of Medical Science (1971 -) Aims and scope Submit manuscript

Abstract

Background

New-onset diabetes after transplant (NODAT) confers risk of diabetes-related complications as well as a threat to graft function and overall patient survival. The reported incidence of NODAT varies from 14 to 37% in renal transplant recipients worldwide; however, NODAT is yet to be studied in the Irish renal transplant population.

Aims

Primary aims of this project were to estimate the incidence, to determine associated risk factors and to assess the long-term consequences of NODAT on graft survival and patient survival in the Irish renal transplant population.

Methods

Retrospective data collection of 415 renal transplant recipients over a 12-year period was performed to record presence of NODAT, patient characteristics and perioperative management. Preoperative screening was reviewed in a subgroup of patients to determine concordance with the International Consensus Guidelines. Statistical analysis was performed using Kaplan-Meier survival functions estimating NODAT detection over time, graft and patient survival. Risk factor association was determined using Cox proportional-hazards models.

Results

NODAT incidence was 10.2% in the first 5 years of post-transplant. Risk factors for developing NODAT were recipient age and body weight. Risk of NODAT was highest in the first year of post-transplant and conferred decreased patient survival; however, it did not significantly affect graft survival. Only seven patients of a subgroup of 21 patients who developed NODAT had preoperative testing for diabetes.

Conclusions

NODAT incidence in the Irish renal transplant population is slightly below international figures. This project has highlighted current deficits in the national transplant guidelines for the detection of NODAT and NODAT-related risk factors.

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Authors and Affiliations

  1. Academic Department of Endocrinology and Diabetes, Beaumont Hospital and the RCSI, Dublin, Ireland

    Maria Tomkins, Roxana M. Tudor & Diarmuid Smith

  2. Transplant, Urology, Nephrology Directorate, Beaumont Hospital, Dublin, Ireland

    Kevin Cronin, Patrick O’Kelly, Yvonne Williams, Dilly Little, Declan G. de Freitas, Mark Denton, Conall O’Seaghdha & Peter Conlon

Authors
  1. Maria Tomkins
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  2. Roxana M. Tudor
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  4. Patrick O’Kelly
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  5. Yvonne Williams
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  6. Dilly Little
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  7. Declan G. de Freitas
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  8. Mark Denton
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  9. Conall O’Seaghdha
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  10. Peter Conlon
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  11. Diarmuid Smith
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Contributions

Material preparation, data collection and analysis were performed by Maria Tomkins, Patrick O’Kelly, Yvonne Williams, Kevin Cronin and Roxana Tudor. The first draft of the manuscript was written by Maria Tomkins and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Maria Tomkins.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

For the purpose of this audit, ethical approval was not required. All procedures performed were in accordance with the standards of the institutional audit committee of Beaumont Hospital.

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Informed consent was not required for the purposes of this audit.

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Tomkins, M., Tudor, R.M., Cronin, K. et al. Risk factors and long-term consequences of new-onset diabetes after renal transplantation. Ir J Med Sci 189, 497–503 (2020). https://doi.org/10.1007/s11845-019-02112-6

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  • DOI: https://doi.org/10.1007/s11845-019-02112-6

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