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Pre-transplant HbA1c and risk of diabetes mellitus after kidney transplantation: a single center retrospective analysis

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Abstract

Background

Post-transplant diabetes mellitus occurs in 10–40% of kidney transplant recipients and is associated with increased risk of developing cardiovascular diseases. Early identification of patients with a higher risk of developing diabetes could allow to take timely measures. However, no validated model exists to predict the risk of post-transplant diabetes mellitus.

Methods

This retrospective study includes 267 adult patients who underwent kidney transplantation at the Antwerp University Hospital between January 2014 and August 2021. Post-transplant diabetes mellitus was diagnosed based on the American Diabetes Association definition at 3 months post-transplant. First, a logistic regression analysis was used to identify predictors for post-transplant diabetes mellitus. Second, criteria to identify patients with a high risk (> 35%) of developing post-transplant diabetes mellitus at 3 months were established.

Results

At 3 months post-transplantation, 54 (20.2%) patients developed post-transplant diabetes mellitus. Univariable analysis showed that age, body mass index and HbA1c on the day of transplantation were associated with post-transplant diabetes mellitus. However, in a multivariable model with the same parameters, only HbA1c remained statistically significant. An absolute increase in HbA1c of 0.1% increases the odds for developing post-transplant diabetes mellitus by 28% (95% confidence interval 1.15–1.42). An HbA1c level ≥ 5.3% at transplantation, regardless of age or body mass index, is sufficient to identify patients with a post-transplant diabetes mellitus risk of ≥ 35% with a positive predictive value of 39% and a negative predictive value of 88%.

Conclusions

The HbA1c value at transplantation was the strongest predictor for post-transplant diabetes mellitus at 3 months post-transplant. Furthermore, at least in our population, a pre-transplant HbA1c of ≥ 5.3% can be used as an easy tool to identify patients at high risk of early post-transplant diabetes mellitus.

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Acknowledgements

We would like to express our sincere gratitude to all those who supported us during the research and writing of this article. We would like to thank Ella Roelant for statistical advice. Last but not least, we would like to thank Erik Snelders. Without him, this article would not have been possible.

Funding

No funds, grants, or other support was received.

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Author notes

  1. Joint last authors: Christophe De Block and Rachel Hellemans.

Authors and Affiliations

  1. Department of Nephrology-Hypertension, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Yassine Laghrib, Annick Massart, Johan Willem de Fijter, Daniel Abramowicz & Rachel Hellemans

  2. Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium

    Christophe De Block

  3. Laboratory of Experimental Medicine and Pediatrics (LEMP), Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Yassine Laghrib, Annick Massart, Johan Willem de Fijter, Daniel Abramowicz, Christophe De Block & Rachel Hellemans

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  1. Yassine Laghrib
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The data underlying this article will be shared on reasonable request to the corresponding author.

Corresponding author

Correspondence to Yassine Laghrib.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This retrospective study involving kidney transplant recipients was in accordance with the ethical standards of the institutional research ethical committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Ethics approval was obtained before the start of the study (Project ID3680 – EDGE 2657).

Informed consent

This was a retrospective study. There is no informed consent asked specifically for this study, however transplant patients sign a consent for data collection for future studies.

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Laghrib, Y., Massart, A., de Fijter, J.W. et al. Pre-transplant HbA1c and risk of diabetes mellitus after kidney transplantation: a single center retrospective analysis. J Nephrol 36, 1921–1929 (2023). https://doi.org/10.1007/s40620-023-01623-x

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  • DOI: https://doi.org/10.1007/s40620-023-01623-x

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