• Vol. 40 No. 4, 160–167
  • 15 April 2011

Incidence and Risk Factors for Development of New-onset Diabetes after Kidney Transplantation

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ABSTRACT

Introduction: New-onset diabetes after transplantation (NODAT) is an increasingly recognised metabolic complication of kidney transplantation that is associated with increased morbidity and mortality. This study aimed to determine the incidence of NODAT and identify risk factors for development of NODAT among kidney allograft recipients in a single centre.

Materials and Methods: We retrospectively reviewed all kidney allograft recipients in our centre between 1998 and 2007. NODAT were determined using criteria as per American Diabetes Association guidelines. Logistic regression analyses were performed to identify predictors of NODAT.

Results: Among 388 patients included in the analysis, NODAT was reported in 94 patients (24.2%) after a median follow-up time of 52.1 months. The cumulative incidence of NODAT was 15.8%, 22.8% and 24.5% at 1, 3, and 5 years following transplantation. Seven clinical factors were independent predictors of NODAT: older age, HLA B13 and B15 phenotypes, use of sirolimus, acute rejections, higher pre-transplant and post-transplant (day 1) plasma glucose levels. Patients with NODAT had poorer outcomes in both graft and patient survival.

Conclusion: Our study demonstrates a significant risk and burden of NODAT in an Asian transplant population. Risk stratification and aggressive monitoring of blood glucose early post-transplantation is necessary to identify high-risk patients so that appropriate tailoring of immunosuppression and early institution of lifestyle modifications can be implemented.


The development of new-onset diabetes after transplantation (NODAT) is a serious metabolic complication of kidney transplantation that predisposes patients to graft dysfunction, cardiovascular disease and death. Although NODAT has been recognised for many years, the true incidence has been difficult to establish due to inconsistencies in the definition of diabetes mellitus employed in clinical studies, and estimates vary widely from 2% to 50% in the first post-transplant year. In recent years, clinicians have adopted the strict definitions of diabetes mellitus defined by American Diabetes Association (ADA) in an attempt to better define the incidence of this disorder. Several risk factors have been shown to be independent predictors of NODAT. These include older age, higher body mass index, ethnicity, hepatitis C positive patients and the use of tacrolimus. Identifying high-risk patients based on these factors may improve long-term outcome by allowing tailoring of immunosuppression and early institution of lifestyle modifications.

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