期刊
NEPHROLOGY DIALYSIS TRANSPLANTATION
卷 23, 期 4, 页码 1436-1441出版社
OXFORD UNIV PRESS
DOI: 10.1093/ndt/gfm762
关键词
insulin resistance; NODAT; tacrolimus
Background. Insulin resistance precedes overt diabetes in the general population and hypertriglyceridemia is a reliable marker of the disorder. Thus, patients in the waiting list with hypertriglyceridemia may be at risk for new-onset diabetes after transplantation ( NODAT). Objectives. We investigate whether pre-transplant triglyceride ( TG) levels are a risk factor for NODAT and whether they exert a combined effect with the type of calcineurin inhibitor ( CNI). Methods. We analysed 314 consecutive non-diabetic recipients [ 215 cyclosporine A ( CsA); 99 tacrolimus ( Tacro)] transplanted between 1999 and 2003 with a mean followup of 34 months. Outcome was NODAT defined by ADA criteria. Results. NODAT developed in 81 recipients ( 25.8%). Multivariate analysis which included a propensity score for factors determining CNI allocation showed that age ( OR: 1.06; 95% CI: 1.03 - 1.09), pre-transplant BMI ( OR: 1.1; 95% CI: 1.02 - 1.17), TG levels ( OR: 1.3 per 50 mg/ dl increment, 95% CI: 1.07 - 1.6) and treated acute rejection ( OR: 4.8, 95% CI: 3 - 11), but not the type of CNI, were independent risk factors for NODAT. A significant interaction between pre- transplant TG and type of CNI was observed. Using CsA as the reference, the combination of Tacro plus pretransplant hypertriglyceridemia (>= 200 mg/ dl) showed an OR of 3.26 ( 1.4 - 7.8) to develop NODAT, contrasting with an OR of 0.75 ( 0.34 - 1.6) in Tacro recipients with pretransplant TG levels <200 mg/ dl. Conclusion. Pre-transplant hypertriglyceridemia was a risk factor for NODAT only in recipients treated with Tacro; it highlights the importance of pre- transplant insulin resistance in the pathogenesis of NODAT.
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