Post-transplant diabetes mellitus in children following renal transplantation

• Published in: Pediatric transplantation Vol. 12; no. 6; pp. 643 - 649
• Main Authors: Prokai, A., Fekete, A., Kis, E., Reusz, G. S., Sallay, P., Korner, A., Wagner, L., Tulassay, T., Szabo, A. J.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-09-2008; Blackwell
• Subjects: Administration, Oral; Adolescent; Adult; Biological and medical sciences; Blood Glucose - metabolism; Child; children; Diabetes Mellitus - diagnosis; Diabetes Mellitus - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Immunosuppressive Agents - therapeutic use; Kidney Diseases - therapy; kidney transplantation; Kidney Transplantation - adverse effects; Male; Medical sciences; Methylprednisolone - administration & dosage; post-transplant diabetes mellitus; steroids; Steroids - pharmacology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; tacrolimus; Tacrolimus - adverse effects; Endocrinopathy; Steroid; Pediatrics; Calcineurin inhibitor; Homotransplantation; Kidney; children; Surgery; Graft; Protein synthesis inhibitor; Child; Human; Postoperative; Corticosteroid; Diabetes mellitus; post-transplant diabetes mellitus; Lactone; Macrolide; Immunomodulator; Treatment; Urinary system; Tacrolimus; steroids; Immunosuppressive agent; Antibacterial agent; Kidney transplantation
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/j.1399-3046.2007.00862.x

:  PTDM plays a role in chronic allograft nephropathy and decreases graft and patient survival. Considering the serious outcome of chronic hyperglycemia, the importance of early recognition and the few data in children, in this retrospective analysis we studied the characteristics and risk factors of PTDM in 45 pediatric renal transplant recipients receiving Tac or CyA‐based immunosuppression. Fasting blood sampling and OGTT were performed. PTDM has been developed in six patients (13%), while seven children (16%) had IGT, with the overall incidence of a glucose metabolic disorder of 29% in pediatric renal transplants. Patients in the PTDM + IGT group were younger and had higher systolic blood pressure and serum triglyceride level than children with normal glucose tolerance. Multivariate analysis identified Tac treatment, Tac trough level, steroid pulse therapy and family history of diabetes to be associated with the onset of PTDM. In pediatric renal transplants, OGTT and frequent assessment of blood glucose levels might be essential not only in the post‐transplant management, but also prior to transplantation, particularly with family history of diabetes. Careful monitoring and modified protocols help to minimize the side effects of Tac and corticosteroids.