PHILADELPHIA—Significant weight loss prior to kidney transplantation may lessen the risk of new-onset diabetes after transplantation (NODAT), according to study findings presented at the 2015 American Transplant Congress.
A study by investigators at the University of California Los Angeles led by Edmund Huang, MD, found that renal transplant recipients with the most profound weight loss had a significant 25% decreased odds of NODAT compared with recipients with the most weight gain in multivariate analysis.
“Out of all the risk factors for new-onset diabetes after transplant, weight is probably the only modifiable risk factor,” Dr. Huang told Renal & Urology News. Weight loss may contribute to a decrease in NODAT risk by improving insulin sensitivity, he noted.
Dr. Huang’s team studied 9,681 recipients without diabetes at wait listing who were later identified as diabetics on recipient follow-up (the NODAT group) and a comparison group of 61,992 recipients without diabetes. The investigators defined pre-transplant weight change as the percentage difference in body mass index (BMI) between waitlisting and transplant. They stratified recipients into quartiles according to pre-transplant weight change, with quartile 1 including patients with the greatest weight gain and quartile 4 including those with the greatest weight loss. The 95% confidence interval for the predicted probability of NODAT ranged from 9.2%–23.5% for quartile 1 compared with 7.1%–18.9% for quartile 4.
They also stratified recipients according to BMI (less than 18.5, 18.5–24.9, 25.0–29.9, 30.0–39.9, and 40 kg/m2 or higher). Although NODAT risk increased with increasing BMI, pre-transplant weight loss among recipients in quartile 4 had a mitigating effect on NODAT in all BMI categories.