Abstrait

Risk for new-onset diabetes mellitus after transplantation: implication of advanced age and immunosuppressive therapy

Moro O Salifu, Dale Distant, Dhiren M Haria, Mariya Stratilatova, Sheni Meghani, Joon Hong, Nabil Sumrani, Eli Friedman and Mariana S Markell

Background: The impact of the type of calcineurin inhibitor on the development of new-onset diabetes after transplantation (NODAT) has been difficult to assess due to contradictory results in published studies using heterogeneous populations. Aim: We attempted to assess the relative risk for development of NODAT in a population of age-stratified Afro–Caribbean and Hispanic renal-transplant recipients treated with cyclosporin A (CSA) or tacrolimus in an urban academic medical center (n = 284). Patients & methods: Patients, based on age distribution, were divided into group 1 (20–44 years; n = 85); group 2 (45–56 years; n = 110); and group 3 (57–79 years; n = 85). Results: In each age group, tacrolimus-treated patients had significantly higher rates of NODAT (7, 17 and 15%) compared with CSA-treated patients (2, 9 and 7%); p = 0.015. The risk of NODAT was increased in age group 2 (hazard ratio: 4.7; 95% confidence interval: 2.0–11.0; p = 0.01) and group 3 (hazard ratio :3.4; 95% confidence interval: 1.4–8.5; p = 0.01) compared with group 1 and use of tacrolimus compared with CSA (hazard ratio: 2.7; 95% confidence interval: 1.4–5.0; p = 0.01). Race, gender, acute rejection episodes and other demographic factors were insignificant factors between the age groups. Conclusion: We conclude that, in our population, the risk of NODAT increases with age and use of tacrolimus. Discrepancies in assigning risk to immunosuppressive regimens in previous studies may be confounded by the analysis of mixed age groups or predominantly younger patients.