DIABETES-MELLITUS AFTER RENAL-TRANSPLANTATION - AS DELETERIOUS AS NON-TRANSPLANT-ASSOCIATED DIABETES

Background. Despite use of lower doses of corticosteroid hormones afte r renal allotransplantation in the era of cyclosporine and tacrolimus, posttransplant diabetes mellitus remains a common clinical problem, M ethods, We prospectively investigated the effect of posttransplant dia betes on long-term (mean follow-up, 9.3+/-1.5 years) graft and patient survival in the 11.8% of our renal transplant population (n=40) who d eveloped diabetes after kidney transplantation, and we compared outcom e in 38 randomly chosen nondiabetic control patients who had received transplants concurrently, Results, Twelve-year graft survival in diabe tic patients was 48%, compared with 70% in control patients (P=0.04), and Cox's regression analysis revealed diabetes to be a significant pr edictor of graft loss (P=0.04, relative risk=3.72) independent of age, sex, and race, Renal function at 5 years as assessed by serum creatin ine level was inferior in diabetic patients compared to control patien ts (2.9+/-2.6 vs, 2.0+/-0.07 mg/dl, P=0.05), Two diabetic patient who experienced graft loss had a clinical course and histological features consistent with diabetic nephropathy; other diabetes-related morbidit y in patients with posttransplant diabetes included ketoacidosis, hype rosmolar coma or precoma, and sensorimotor peripheral neuropathy, Pati ent survival at 12 years was similar in diabetic and control patients (71% vs, 74%). Conclusions, Posttransplant diabetes mellitus is associ ated with impaired long-term renal allograft survival and function, co mplications similar to those in non-transplant-associated diabetes may occur in posttransplant diabetes, and, hence, as in non-transplant-as sociated diabetes, tight glycemic control may also be warranted in pat ients with posttransplant diabetes.