Background

1. Is it possible to predict New Onset Diabetes After Transplantation (NODAT) in renal recipients using epidemiological data alone? S J Robinson, SM Eckoldt, RC Andrews and RM Smith. Academic Renal Unit, Clinical Sciences at North Bristol. • Background • NODAT is an important complication of renal transplantation that is associated with decreased graft and patient survival1. • Many risk factors have been linked to NODAT including age, male gender, Afrocaribean ethnicity, CMV infection, BMI and use of tacrolimus2. Unfortunately the majority of published work is unreliable due to inconsistencies regarding the definition of NODAT and the lack of consistency in the exposure to immunosuppression. • This audit aimed to identify epidemiological risk factors for the development of NODAT in our renal transplant population. • Patients and Methods • A retrospective study of 306 consecutive adult patients with end-stage renal disease who underwent a kidney transplant from September 2004 to October 2007 at our unit. Follow-up was up to 31st May 2008. • Data was drawn from the hospital’s electronic database and manually checked against a list recorded by the transplant coordinators. • NODAT was diagnosed if two random plasma glucose measurements were greater than 11.0 mmol/L. • A total of 39 (12.7%) with pre-existing diabetes were excluded, the remaining 267 were included in the analysis. Results The mean follow-up time of the patients was 365 days. The incidence of NODAT was 15.4% (42 / 267). The average time to onset of NODAT was 41 days (Standard Deviation 55), the range was 11 to 156 days. Table 1 shows the demographic and outcomes of the renal transplant recipients. The significant associations to NODAT are age at transplant, family history and Autosomal Dominant Polycystic Kidney Disease (ADPKD) as the cause of the End Stage Renal Disease. Graph 1 shows timeline for resolution, 12 of the 22 resolving within 3 months of diagnosis. Table 2 shows that 16 of the 18 who were managed with lifestyle advice went onto resolve. Table 3 depicts the results of the Logistic regression performed on the variables collected in the audit. Age at transplant and family history of diabetes are independent predictors of NODAT, with Odds Ratios of 1.047 and 4.176 respectively. Table 1: Demographic features and outcome of the recipients Graph 1: Time to resolution Table 2: Treatment of NODAT Table 3: Logistic regression analysis of the effect of epidemiological factors on the development of NODAT Conclusions NODAT is a common, early complication of renal transplantation in our unit. Approximately half the cases resolve before one year. Age and family history of diabetes were the only independent risk factors for NODAT in this cohort. Although Autosomal Dominant Polycystic Kidney Disease was shown to be associated with the development of NODAT on univariate analysis, this was not an independent risk factor on multivariate analysis. There was no significant difference between mortality rates between those who develop NODAT and those who do not. There was also no difference in graft survival. • References • Cosio et al ,Patient survival after renal transplantation: IV Impact of post-transplant diabetes. Kidney International 2002; 62(4): 1440-6 • 2Montori et al, Posttransplant diabetes: a systematic review of the literature. Diabetes Care 2002; 25(3);583-92