Posttransplant Diabetes Mellitus and Immunosuppression Selection in Older and Obese Kidney Transplant Recipients

ABSTRACT Rationale & objective Posttransplant diabetes mellitus (DM) after kidney transplantation increases morbidity and mortality, particularly in older and obese recipients. In this study, we aimed to examine the impact of immunosuppression selection on the risk of posttransplant DM among both older and obese kidney transplant recipients. Study design Retrospective database study. Setting & participants: Kidney-only transplant recipients aged ≥18 years from 2005 to 2016 in the United States from U.S. Renal Data System (USRDS) records, which integrate Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) records with Medicare billing claims. Exposures Various immunosuppression regimens. Outcomes Development of posttransplant DM. Analytical approach We used multivariable Cox regression to compare the incidence of posttransplant DM by immunosuppression regimen with the reference regimen thymoglobulin (TMG) or alemtuzumab (ALEM) with tacrolimus + mycophenolic acid + prednisone using inverse propensity weighting. Results 12.7% of kidney transplant recipients developed posttransplant DM with higher incidences in older (≥55 years vs. Limitations Retrospective study and limited data on immunosuppression levels. Conclusions The beneficial impact of steroid avoidance using tacrolimus on posttransplant DM appears to differ by patient age and induction regimen.