High impact of rejection therapy on the incidence of post-transplant diabetes mellitus after kidney transplantation.

Abstract: Background: Although major risk factors for post-transplant diabetes (PTDM) after kidney transplantation have beenidentified, a systematic study on the impact of rejection and rejectiontherapy is missing so far.Methods: Five hundred and twenty-six kidney transplant recipientstransplanted in the years 2000–2007 were included. PTDM was definedaccording to WHO guidelines, and patients’ data were compared withspecial attention to protocol and for cause biopsies and rejectiontherapies. Survival analyses were made for graft loss and patient death.Results: 16.7% of all patients developed PTDM. Among common riskfactors as higher age, body mass index (BMI), and others, the factor“acute cellular rejections” was comparably most relevant with a hazardratio of 3.7. Consequently, antirejective treatment with steroid pulsesand conversion to tacrolimus was the factor with the highest relativerisk for the onset of PTDM (RR 3.5). PTDM itself had no impact ongraft or patients’ survival, but the decreased graft survival in PTDMpatients was dominantly influenced by the higher frequency of acutecellular rejections, and patients’ survival was reduced due to higherage.Conclusion: Based upon a higher rate of acute rejections (AR), thenecessity of frequent antirejective treatments was more relevant for theinduction of PTDM than age or BMI.Torben Schweer, WilfriedGwinner, Irina Scheffner, AnkeSchwarz, Hermann Haller andCornelia Blume