COMPLICATIONS - METABOLIC

S. Guleria¹, G. Bora¹, N. Tandon², N. Gupta², S. Agarwal¹, S. Gupta³, D. Bhowmik³, S.K. Agarwal^4
1Deptt Of Surgery, All India Institute of Medical Sciences, New Delhi/INDIA, ²Deptt. Of Endocrinology And Metabolism, All India Institute of Medical Sciences, New Delhi/INDIA, ³Deptt Of Nephrology, All India Institute of Medical Sciences, New Delhi/INDIA, ⁴Nephrology, All India Institute of Medical Sciences, New Delhi/INDIA

Body: Introduction: New Onset Diabetes Mellitus (NODM) developing after transplantation is associated with unfavourable outcomes including graft failure, death and infection. The identification of modifiable risk factors for the development of NODM may help in risk reduction. The present study was carried out to identify such risk factors Methods :80 patients suffering from ESRD who were awaiting a live related renal transplant were investigated pre-operatively and followed up post operatively for one year for the development of NODM. Patients with overt diabetes, less than 18 years of age or those undergoing a second transplant were excluded from the study. All patients who were HCV or HBV positive were given Cyclosporine based immunosuppression with Mycophenolate Mofetil and Steroids. Non HCV and HBV were given Tacrolimus , Mycophenolate Mofetil and Steroids. Steroids were commenced at 20 mg per day and reduced to 10 mg by six months and 5 mg by one year. Cyclosporine and Tacrolimus were given according to a standard drug protocols using drug levels at frequent intervals. The factors studied were age , BMI, Waist/ Hip ratio, duration of dialysis, Plasma glucose fasting and post prandial glucose at 1, 3 ,6 months and one year. The C Peptide level, Insulin level and insulin resistance indices namely Homeostasis Model Assessment –Insulin resistance ( HOMA- IR) were also assessed. Post transplant immunosuppression and graft outcome were also analysed .The ADA guidelines were used for the diagnosis of diabetes, Impaired fasting glucose Results: 78 patients completed the study. 65.4% of the recipients were below 40 years and 34.6% were above forty years. There were 65 males and thirteen females. The mean BMI of the below 40 years age group was 19.2 and the ones above 40 years was 20. 37 patients had a waist /hip ratio of more than 1 while 19 patients had a family history of diabetes. 14 patients were positive for HCV and 2 for HBV. Tacrolimus based immunosuppression was given in 62 patients and Cyclosporine based immunosuppression in 16. The cumulative incidence of NODM was 16.75% at one year post-renal transplantation. More than half of the patients (61.5%) with NODM developed new-onset diabetes within the first 3 months. Pre-transplant fasting C-peptide values did not predict development of NODM. Insulin resistance and mean fasting insulin levels were higher in NODM group pre transplant but were not significantly associated with NODM. No Significant difference in the incidence of NODM was found between Tacrolimus and Cyclosporine based immunosuppression. Conclusion: Advanced age , Impaired fasting glucose and family history of diabetes were the only factors identified as significant risk factors for the development of NODM. Weight, BMI and waist/hip ratio did not correlate with NODM as no patient in our study group was overweight or obese. Low incidence of NODM in HCV positive population in our study was due to use of cyclosporine instead of tacrolimus. Based on the presence of these risk factors for NODM, individualized post transplant management should include considerations for the choice of the initial immunosuppressant and modification

Disclosure: All authors have declared no conflicts of interest.