Joseph B. Lockridge MD , Joseph B. Pryor MD , Megan N. Stack FNP , Shehzad S. Rehman MD , Douglas J. Norman MD , Angelo M. DeMattos MD , Ali J. Olyaei PharmD
{"title":"New onset diabetes after kidney transplantation in Asian Americans – Is there an increased risk?","authors":"Joseph B. Lockridge MD , Joseph B. Pryor MD , Megan N. Stack FNP , Shehzad S. Rehman MD , Douglas J. Norman MD , Angelo M. DeMattos MD , Ali J. Olyaei PharmD","doi":"10.1016/j.tpr.2021.100080","DOIUrl":null,"url":null,"abstract":"<div><h3>Summary</h3><p>New-onset diabetes after transplantation (NODAT) is increasing in frequency and creates many challenges directly impacting the patient and graft survival. Most transplant programs offer a fixed-dose prednisone taper schedule for the prevention of acute rejection following kidney transplantation. In this study, we investigated the incidence of NODAT in new kidney transplant recipients.</p></div><div><h3>Methods</h3><p>This was a retrospective, single-center study assessing rates of NODAT according to age, ethnicity, body weight, BMI, rejection, and prednisone dosing among kidney transplant recipients.</p></div><div><h3>Results</h3><p>Among non-diabetic consecutive kidney transplant recipients (<em>n</em> = 261) from 1/2014 to 12/2018, a total of 47 (18%) kidney transplant recipients developed NODAT. After adjusting for common NODAT risk factors, analysis of the population indicated that age, and corticosteroid dose in the Asian American population [adjusted for lower body weight, BMI] significantly increased the risk of NODAT. In multi-variance analysis, despite receiving lower standard doses of protocol corticosteroid daily, when adjusted for actual body weight (mg/kg/day) Asian American recipients had high incidence of NODAT compared to other ethnicity. Asian American received higher doses or corticosteroids (prednisone) than non-Asian Americans (0.14 mg/kg vs. 0.11 mg/kg) (<em>p</em> = 0.008). The overall incidence of rejection was not higher among those who developed NODAT (<em>p</em> = 0.55)</p></div><div><h3>Conclusion</h3><p>This is the first study to explore the relationship between corticosteroid dose and diabetes in Asian Americans. Asian Americans had higher rates of NODAT and received higher doses of weight-based corticosteroids. There is a possible iatrogenic, pharmacogenomic, and addressable etiology to NODAT in this population.</p></div>","PeriodicalId":37786,"journal":{"name":"Transplantation Reports","volume":"6 3","pages":"Article 100080"},"PeriodicalIF":0.0000,"publicationDate":"2021-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.tpr.2021.100080","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Reports","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2451959621000081","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 1
Abstract
Summary
New-onset diabetes after transplantation (NODAT) is increasing in frequency and creates many challenges directly impacting the patient and graft survival. Most transplant programs offer a fixed-dose prednisone taper schedule for the prevention of acute rejection following kidney transplantation. In this study, we investigated the incidence of NODAT in new kidney transplant recipients.
Methods
This was a retrospective, single-center study assessing rates of NODAT according to age, ethnicity, body weight, BMI, rejection, and prednisone dosing among kidney transplant recipients.
Results
Among non-diabetic consecutive kidney transplant recipients (n = 261) from 1/2014 to 12/2018, a total of 47 (18%) kidney transplant recipients developed NODAT. After adjusting for common NODAT risk factors, analysis of the population indicated that age, and corticosteroid dose in the Asian American population [adjusted for lower body weight, BMI] significantly increased the risk of NODAT. In multi-variance analysis, despite receiving lower standard doses of protocol corticosteroid daily, when adjusted for actual body weight (mg/kg/day) Asian American recipients had high incidence of NODAT compared to other ethnicity. Asian American received higher doses or corticosteroids (prednisone) than non-Asian Americans (0.14 mg/kg vs. 0.11 mg/kg) (p = 0.008). The overall incidence of rejection was not higher among those who developed NODAT (p = 0.55)
Conclusion
This is the first study to explore the relationship between corticosteroid dose and diabetes in Asian Americans. Asian Americans had higher rates of NODAT and received higher doses of weight-based corticosteroids. There is a possible iatrogenic, pharmacogenomic, and addressable etiology to NODAT in this population.
期刊介绍:
To provide to national and regional audiences experiences unique to them or confirming of broader concepts originating in large controlled trials. All aspects of organ, tissue and cell transplantation clinically and experimentally. Transplantation Reports will provide in-depth representation of emerging preclinical, impactful and clinical experiences. -Original basic or clinical science articles that represent initial limited experiences as preliminary reports. -Clinical trials of therapies previously well documented in large trials but now tested in limited, special, ethnic or clinically unique patient populations. -Case studies that confirm prior reports but have occurred in patients displaying unique clinical characteristics such as ethnicities or rarely associated co-morbidities. Transplantation Reports offers these benefits: -Fast and fair peer review -Rapid, article-based publication -Unrivalled visibility and exposure for your research -Immediate, free and permanent access to your paper on Science Direct -Immediately citable using the article DOI