The incidence and risk factors for new-onset diabetes after transplantation in kidney allograft recipients

Background: New-onset diabetes after transplantation (NODAT) of a kidney is a serious metabolic complication that can lead to graft dysfunction, cardiovascular disease, and death. The aims of this retrospective study were to determine the incidence of NODAT and the risk factors for its development in kidney allograft recipients at our institution. Methods: The records of patients free of previously known diabetes who received kidney transplants at the First Hospital of China Medical University from January 2005 to December 2012 were reviewed. NODAT was identified based on the criteria of the American Diabetes Association. Cox proportional hazards regression analysis was performed to identify the predictors of NODAT, using age, gender, and history of hypertension as covariates. Results: The patients were followed for a mean duration of 52.1 +/- 10.8 months. Among 197 patients, 20 (10.15%) developed NODAT. The cumulative incidence of NODAT was 7.6%, 8.6%, and 10.2% at 6 months, 1 year, and 3 years following transplantation, respectively. Patients developing NODAT after transplantation were significantly older (48.1 +/- 5.57 vs 43.36 +/- 11.37 years; P= 0.004) and had a tendency to have a higher body mass index (22.26 +/- 2.89 vs 21.85 +/- 2.87 kg/m(2); P= 0.544) than patients without NODAT. Multivariate analysis identified the following clinical factors as independent predictors of NODAT: higher pretransplantation levels of plasma glucose, alanine aminotransferase, and total cholesterol; a lower pretransplantation high-density lipoprotein cholesterol level; and a higher post-transplantation alkaline phosphatase level. Conclusions: Patients undergoing kidney transplantation should undergo risk assessment for development of NODAT.