SP747SUCCESSFUL HCV THERAPY WITH NOVEL DAA REGIMEN IMPROVES GLUCOSE TOLERANCE AND MAY PREVENT POST-TRANSPLANT DIABETES MELLITUS IN RENAL TRANSPLANT RECIPIENTS

Post-transplant diabetes mellitus (PTDM) is a frequent and relevant complication after renal transplantation: it affects 20–30% of renal transplant recipients and increases the risk for cardiovascular and infectious events. Thus, understanding pathogenesis of PTDM would help limiting its consequences. In this review, we analyse novel aspects of PTDM, based on studies of the last decade, such as the clinical evolution of PTDM, early and late, the reversibility rate, diagnostic criteria, risk factors, including pre-transplant metabolic syndrome and insulin resistance (IR) and the interaction between these factors and immunosuppressive medications. Also, we discuss novel pathogenic factors, in particular the role of β-cell function in an environment of IR and common pathways between pre-existing cell damage and tacrolimus-induced toxicity. The relevant role of prediabetes in the pathogenesis of PTDM and cardiovascular disease is also addressed. Finally, current evidence on PTDM treatment is discussed.

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High Plasma Branched-Chain Amino Acids Are Associated with Higher Risk of Post-Transplant Diabetes Mellitus in Renal Transplant Recipients

Journal of Clinical Medicine ◽

10.3390/jcm9020511 ◽

2020 ◽

Vol 9 (2) ◽

pp. 511 ◽

Cited By ~ 2

Author(s):

Maryse C. J. Osté ◽

Jose L. Flores-Guerrero ◽

Eke G. Gruppen ◽

Lyanne M. Kieneker ◽

Margery A. Connelly ◽

...

Keyword(s):

Diabetes Mellitus ◽

Amino Acids ◽

Renal Transplant ◽

Branched Chain Amino Acids ◽

Resonance Spectroscopy ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Post Transplant ◽

Branched Chain

Post-transplant diabetes mellitus (PTDM) is a serious complication in renal transplant recipients. Branched-chain amino acids (BCAAs) are involved in the pathogenesis of insulin resistance. We determined the association of plasma BCAAs with PTDM and included adult renal transplant recipients (≥18 y) with a functioning graft for ≥1 year in this cross-sectional cohort study with prospective follow-up. Plasma BCAAs were measured in 518 subjects using nuclear magnetic resonance spectroscopy. We excluded subjects with a history of diabetes, leaving 368 non-diabetic renal transplant recipients eligible for analyses. Cox proportional hazards analyses were used to assess the association of BCAAs with the development of PTDM. Mean age was 51.1 ± 13.6 y (53.6% men) and plasma BCAA was 377.6 ± 82.5 µM. During median follow-up of 5.3 (IQR, 4.2–6.0) y, 38 (9.8%) patients developed PTDM. BCAAs were associated with a higher risk of developing PTDM (HR: 1.43, 95% CI 1.08–1.89) per SD change (p = 0.01), independent of age and sex. Adjustment for other potential confounders did not significantly change this association, although adjustment for HbA1c eliminated it. The association was mediated to a considerable extent (53%) by HbA1c. The association was also modified by HbA1c; BCAAs were only associated with renal transplant recipients without prediabetes (HbA1c < 5.7%). In conclusion, high concentrations of plasma BCAAs are associated with developing PTDM in renal transplant recipients. Alterations in BCAAs may represent an early predictive biomarker for PTDM.

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POST TRANSPLANT DIABETES MELLITUS IN PEDIATRIC RENAL TRANSPLANT RECIPIENTS: A REPORT OF THE NORTH AMERICAN PEDIATRIC RENAL TRANSPLANT COOPERATIVE STUDY (NAPRTCS)

Transplantation Journal ◽

10.1097/00007890-199805131-00054 ◽

1998 ◽

Vol 65 (Supplement) ◽

pp. 92

Author(s):

A Al-Uzri ◽

R A Cohn ◽

E K Sullivan

Keyword(s):

Diabetes Mellitus ◽

Renal Transplant ◽

North American ◽

Renal Transplant Recipients ◽

Cooperative Study ◽

Transplant Recipients ◽

Post Transplant ◽

The North ◽

Pediatric Renal Transplant ◽

Pediatric Renal Transplant Recipients

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A prospective observational study on the traditional and novel risk factors associated with post-transplant diabetes mellitus in renal transplant recipients

Biomedicine ◽

10.51248/.v41i2.1063 ◽

2021 ◽

Vol 41 (2) ◽

pp. 482-488

Author(s):

Krithika Muralidhara ◽

Subramanian Kannan ◽

Ishthiaque Ahamed ◽

Krishna Kishore ◽

Llyod Vincent ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Transplant ◽

Trace Element ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Post Transplant ◽

Factors Associated ◽

Novel Risk Factors ◽

Traditional Risk Factors

Introduction and Aim: Post Transplant Diabetes Mellitus (PTDM) constitutes a major co-morbidity that has significant impact on the patient and renal allograft outcome. Various traditional risk factors like dialysis vintage, immunosuppressive medication, viral infections have known to be associated with PTDM. Novel risk factors and its causative role in PTDM remains unexplored. The study looked at the incidence of PTDM at 6 months post renal transplantation and correlation of PTDM with known traditional and novel risk factors like pre-transplant C-reactive protein (CRP) level and Trace element deficiency. Material and Methods: 30 consecutive renal transplant recipients more than 18 years of age were inducted into the study. Demographic data, known pre-transplant and post-transplant risk factors associated with development of PTDM were collected. Pre-transplant CRP and serum Trace element (Aluminum, Copper, Selenium and Zinc) levels were estimated. PTDM was diagnosed by home based glucometer monitoring and confirmed by Oral glucose tolerance test (OGTT). Results: The incidence of PTDM was 36.6% at six months post renal transplant. Among the pre-transplant risk factors, higher age and positive family history of diabetes mellitus had a strong association with the occurrence of PTDM. Pre-transplant Zinc deficiency emerged as a significant novel risk factor for the development of PTDM. Conclusion: Apart from known traditional risk factors, novel risk factors are associated with development of PTDM.

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Physical Activity and the Development of Post-Transplant Diabetes Mellitus, and Cardiovascular- and All-Cause Mortality in Renal Transplant Recipients

Journal of Clinical Medicine ◽

10.3390/jcm9020415 ◽

2020 ◽

Vol 9 (2) ◽

pp. 415 ◽

Cited By ~ 3

Author(s):

Oyuntugs Byambasukh ◽

Maryse C. J. Osté ◽

António W. Gomes-Neto ◽

Else van den Berg ◽

Gerjan Navis ◽

...

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Renal Transplant ◽

Mortality Data ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Post Transplant ◽

Glucose Levels ◽

All Cause Mortality

(1) Background: Little is currently known about the health impacts of daily-life moderate-to-vigorous physical activity (MVPA) in relation to the development of post-transplant diabetes mellitus (PTDM) and the long-term survival of renal transplant recipients (RTRs). (2) Methods: We analyzed self-reported data on MVPA within non-occupational and occupational domains, estimated with the SQUASH questionnaire, from a prospective cohort study of RTRs (n = 650) with a functioning graft exceeding 1 year. PTDM diagnoses were based on plasma glucose levels (≥126 mg/dL), HbA1c (≥6.5%), and the use of antidiabetic medication. Mortality data were retrieved from patient files up to the end of September 2015. (3) Results: During a median follow-up period of 5.3 years, 50 patients (10%) developed PTDM and 129 (19.8%) died. Of these deaths, 53 (8.9%) were caused by cardiovascular disease. Cox regression analyses showed that higher MVPA levels among patients were associated with a lower risk of PTDM (hazard ratio (HR); 95% confidence interval (95%CI) = 0.49; 0.25–0.96, p = 0.04), cardiovascular- (0.34; 0.15–0.77, p = 0.01), and all-cause mortality (0.37; 0.24–0.58, p < 0.001) compared with No-MVPA patients, independently of age, sex, and kidney function parameters. Associations of MVPA with cardiovascular and all-cause mortality remained significant and materially unchanged following further adjustments made for transplant characteristics, lifestyle factors, metabolic parameters, medication use, and creatinine excretion (muscle mass). However, the association between MVPA and PTDM was no longer significant after we adjusted for metabolic confounders and glucose levels. (4) Conclusion: Higher MVPA levels are associated with long-term health outcomes in RTRs.

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