Prediabetes in Patients Receiving Tacrolimus in the First Year After Kidney Transplantation: A Prospective and Multicenter Study

• DOI: 10.1097/tp.0b013e31816b16bd
• Publication Date: 2009-03-03T22:41:42Z
• Authors: Esteban Porrini; Jose Manuel Moreno; Antonio Osuna; Rocio Benitez; Ildefonso Lampreabe; Juan Manuel Diaz; Irene Silva; Rosa Domínguez; Julio Gonzalez-Co...; Beatriz Bayes; Ricardo Lauzurica; Meritxell Ibernon; Francisco Moreso; Patricia Delgado; Armando Torres
• Keywords: Adult; Male; 2. Zero hunger; Cholesterol, HDL; prediabetes; Glucose Tolerance Test; Middle Aged; Tacrolimus; Body Mass Index; 3. Good health; 03 medical and health sciences; Logistic Models; 0302 clinical medicine; Risk Factors; insulin resistance; Diabetes Mellitus; Humans; Female; Prospective Studies; tacrolimus; Immunosuppressive Agents; Triglycerides; Aged

Tacrolimus-based immunosuppression, the most widely used regimen in kidney transplantation, increases the risk of new onset diabetes after transplantation (NODAT). However, the prevalence, evolution and risk factors of different prediabetic alterations: impaired fasting glucose, impaired glucose tolerance, and provisional diabetes, have not been established.In this multicenter and prospective study we evaluated 154 nondiabetic kidney transplant recipients receiving tacrolimus, mycophenolate mofetil and low dose steroids. An oral glucose tolerance test was performed 3 and 12 months after transplantation and prediabetes was defined by American Diabetes Association criteria.Prediabetes was highly prevalent and showed little variation between 3 and 12 months (36% and 33%, respectively). Impaired glucose tolerance was the most frequent abnormality observed (23% and 25%, respectively) observed. In addition, 20% of recipients showed NODAT by 1 year. Multivariate analysis showed that age (odds ratio [OR]: 1.07, 95% confidence interval [CI]: 1.004-1.14), pretransplant body mass index (OR: 1.3, CI: 1.09-1.6) and triglyceride/high density lipoprotein-cholesterol ratio, a marker of insulin resistance, (OR: 1.4, CI: 1.05-1.9) were independent risk factors for prediabetes.One in two recipients with tacrolimus-based immunosuppresion showed prediabetes or NODAT by 1 year posttransplantation when properly investigated. Older age and high pretransplant body mass index and triglyceride/high density lipoprotein-cholesterol ratio were risk factors for prediabetes. These findings may help applying early interventions to prevent the disorder.