COMPLICATIONS - METABOLIC

S. Chadban¹, P. Clayton², G. Whitman¹, K. Wyburn¹, B. Butcher³, T. Rees³, G.R. Russ⁴, W. Mulley⁵, A. Irish⁶, D. Dunstan⁷, J. Eris^1
1Transplantation Services, Royal Prince Alfred Hospital, Sydney/AUSTRALIA, ²Transplantation, Royal Prince Alfred Hospital, Sydney/NSW/AUSTRALIA, ³, Janssen-Cilag, Sydney/NSW/AUSTRALIA, ⁴Central Northern Adelaide Renal And Transplantation Service, Royal Adelaide Hospital, Adelaide/AUSTRALIA, ⁵Department Of Medicine, Monash University, Clayton/AUSTRALIA, ⁶, WA Kidney Transplant Service, Perth/WA/AUSTRALIA, ⁷, Baker IDI, Melbourne/AUSTRALIA

Body: Introduction. New Onset Diabetes After Transplantation (NODAT) is common and is predictive of increased mortality. We hypothesised that progressive resistancetraining coupled with dietary advice may improve body composition, decrease insulin resistance and reduce NODAT prevalence. Methods. We conducted a pilot trialof diet and exercise to determine feasibility and examine outcomes. Kidney recipients were enrolled between 6-8weeks after transplantation. We report results for the first 41 subjects (56 planned): 8discontinued prematurely (adverse events(4), non-compliance(1), withdrawal of consent(3)). All received basiliximab, PROGRAF^® (tacrolimus), mycophenolate and steroids. All receiveddietary assessment/advice plus supervised progressive resistance training for 6 months. Assessments included 3-day food diary, anthropometrics, body composition (DEXA), OGTT, kidney function, SF-36.Results. Compliance was generally good. Analysis of the per-protocol population(n=31) comparing baseline to study-end demonstrated trends toward less diabetes(23% v 7%, p=0.10) and diminished insulin resistance (HOMA-IR 1.84±1.2 v 1.64±1.0, prevalence of IR 87% v 69%, p=NS). β–cell function and HbA1c (5.6±0.6 v5.7±0.6) were unchanged. Tacrolimus exposure diminished (12.8±5.4 v 7.5±2.2ng/ml). Despite reductions in measured caloric intake (8789±2421KJ v 7866±1691) andincreased exercise there was no change in BMI (24.5±4.0 v 24.8±4.6).There were no significant safety concerns. Conclusion. A program of diet andexercise was generally well tolerated and was associated with trends toward improvement in metabolic parameters over time. Further results will be available at the conclusion of the trial however acontrolled study is warranted to determine whether diet and exercise may improve metabolic outcomes after transplantation.

Disclosure: All authors have declared no conflicts of interest.