Association of Metabolic Syndrome With Development of New-Onset Diabetes After Transplantation

被引:72
作者
Bayer, Nathaniel D.
Cochetti, Philip T.
Kumar, Mysore S. Anil [2 ]
Teal, Valerie [3 ]
Huan, Yonghong [4 ,5 ]
Doria, Cataldo [4 ,5 ]
Bloom, Roy D.
Rosas, Sylvia E. [1 ,6 ]
机构
[1] Univ Penn, Sch Med, Renal Electrolyte & Hypertens Div, Philadelphia, PA 19104 USA
[2] Drexel Univ, Dept Surg, Philadelphia, PA 19104 USA
[3] Univ Penn, Dept Biostat & Epidemiol, Ctr Clin Epidemiol & Biostat, Philadelphia, PA 19104 USA
[4] Thomas Jefferson Univ, Dept Med, Philadelphia, PA 19107 USA
[5] Thomas Jefferson Univ, Dept Surg, Philadelphia, PA 19107 USA
[6] Vet Adm Med Ctr, Dept Med, Philadelphia, PA 19104 USA
关键词
Renal transplant; NODAT; Metabolic syndrome; HEPATITIS-C VIRUS; POLYCYSTIC KIDNEY-DISEASE; CARDIOVASCULAR RISK-FACTOR; RENAL-TRANSPLANTATION; ALLOGRAFT RECIPIENTS; INSULIN-RESISTANCE; MELLITUS; IMPACT; INFECTION; SURVIVAL;
D O I
10.1097/TP.0b013e3181f1543c
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. New-onset diabetes after transplantation (NODAT) is a major posttransplant complication associated with lower allograft and recipient survival. Our objective was to determine whether metabolic syndrome pretransplant is independently associated with NODAT development. Methods. We recruited 640 consecutive incident nondiabetic renal transplant recipients from three academic centers between 1999 and 2004. NODAT was defined as the use of hypoglycemic medication, a random plasma glucose level more than 200 mg/dL, or two fasting glucose levels more than or equal to 126 mg/dL beyond 30 days posttransplant. Results. Metabolic syndrome was common pretransplant (57.2%). NODAT developed in 31.4% of recipients 1 year posttransplant. Participants with metabolic syndrome were more likely to develop NODAT compared with recipients without metabolic syndrome (34.4% vs. 27.4%, P=0.057). Recipients with increasing number of positive metabolic syndrome components were more likely to develop NODAT (metabolic syndrome score prevalence at 1 year: 0 components-0.0%, 1-24.2%, 2-29.3%, 3-31.0%, 4-34.8%, and 5-73.7%, P=0.001). After adjustment for demographics, age by decade (hazard ratio [HR] 1.34 [1.20-1.50], P<0.0001), African American race (HR 1.35 [1.01-1.82], P=0.043), cumulative prednisone dosage (HR 1.18 [1.07-1.30], P=0.001), and metabolic syndrome (HR 1.34 [1.00-1.79], P=0.047) were independent predictors of development of NODAT at 1 year posttransplant. In a multivariable analysis incorporating the individual metabolic syndrome components themselves as covariates, the only pretransplant metabolic syndrome component to remain an independent predictor of NODAT was low high-density lipoprotein (hazard ratio [HR] 1.37 [1.01-1.85], P=0.042). Conclusions. Metabolic syndrome is an independent predictor for NODAT and is a possible target for intervention to prevent NODAT. Future studies to evaluate whether modification of metabolic syndrome factors pretransplant reduces NODAT development are needed.
引用
收藏
页码:861 / 866
页数:6
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