Abstract
Background: Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies. Methods: Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre-transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time-dependent covariate) was also tested. Results: Median follow-up was 57 mo post-transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non-white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one-half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m2, non-white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)-the highly elevated NODAT rate observed during the first few months post-transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high-dose (intravenous) corticosteroids. Conclusions: The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 301-310 |
| Number of pages | 10 |
| Journal | Clinical Transplantation |
| Volume | 29 |
| Issue number | 4 |
| DOIs | |
| State | Published - Jan 1 2015 |
| Externally published | Yes |
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Keywords
- Kidney transplantation
- Multivariable risk factors
- New onset diabetes after transplant
ASJC Scopus subject areas
- Transplantation
Cite this
Multivariable risk of developing new onset diabetes after transplant-results from a single-center study of 481 adult, primary kidney transplant recipients. / Ciancio, Gaetano; Guerra, Giselle; Sageshima, Junichiro; Hanson, Lois; Roth, David; Goldstein, Michael J.; Chen, Linda; Kupin, Warren; Mattiazzi, Adela; Tueros, Lissett; Flores, Sandra; Barba, Luis J.; Lopez, Adrian; Rivas, Jose; Ruiz, Phillip; Vianna, Rodrigo; Burke, George W.
In: Clinical Transplantation, Vol. 29, No. 4, 01.01.2015, p. 301-310.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Multivariable risk of developing new onset diabetes after transplant-results from a single-center study of 481 adult, primary kidney transplant recipients
AU - Ciancio, Gaetano
AU - Guerra, Giselle
AU - Sageshima, Junichiro
AU - Hanson, Lois
AU - Roth, David
AU - Goldstein, Michael J.
AU - Chen, Linda
AU - Kupin, Warren
AU - Mattiazzi, Adela
AU - Tueros, Lissett
AU - Flores, Sandra
AU - Barba, Luis J.
AU - Lopez, Adrian
AU - Rivas, Jose
AU - Ruiz, Phillip
AU - Vianna, Rodrigo
AU - Burke, George W.
PY - 2015/1/1
Y1 - 2015/1/1
N2 - Background: Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies. Methods: Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre-transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time-dependent covariate) was also tested. Results: Median follow-up was 57 mo post-transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non-white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one-half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m2, non-white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)-the highly elevated NODAT rate observed during the first few months post-transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high-dose (intravenous) corticosteroids. Conclusions: The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.
AB - Background: Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies. Methods: Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre-transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time-dependent covariate) was also tested. Results: Median follow-up was 57 mo post-transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non-white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one-half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m2, non-white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)-the highly elevated NODAT rate observed during the first few months post-transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high-dose (intravenous) corticosteroids. Conclusions: The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.
KW - Kidney transplantation
KW - Multivariable risk factors
KW - New onset diabetes after transplant
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U2 - 10.1111/ctr.12510
DO - 10.1111/ctr.12510
M3 - Article
VL - 29
SP - 301
EP - 310
JO - Clinical Transplantation
JF - Clinical Transplantation
SN - 0902-0063
IS - 4
ER -