New-onset diabetes after renal transplantation is nearly four times more likely with tacrolimus use.

Risk factors for new-onset diabetes after renal transplantation include tacrolimus immunosuppression and older age and heavier weight at the time of transplantation.

Researchers in Scotland reviewed 787 renal transplants performed be-tween 1994 and 2004 at a single center. (Of these patients, 70, or 8.9%, had diabetes before transplantation.) Patients were diagnosed with new-onset diabetes if they had two random plasma glucose concentrations above 11.1 mmol/L after the first month post-transplant or required treatment for hyperglycemia within the first month, and subsequently continued treatment.

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The investigators, led by Nicola Joss, MD, of the Renal Unit Western Infirmary in Glasgow, found a 7.7% incidence of new-onset diabetes and a 4.5% incidence requiring either in-sulin or oral hypoglycemia agents. The researchers published their findings in Clinical Transplantation (2007;21:136-143).

Tacrolimus use was associated with a 3.7 times increased risk of diabetes, according to the study. Each one-year increment in age and each 1-kg (2.2-lb) increase in weight at the time of transplantation were associated with a 4% increased risk of developing the disease.

Diabetes developed in 0.9% of patients younger than 35 years who weight less than 60 kg (132 lb) and in 20.6% of patients older than 50 years who weighted more than 75 kg (165 lb). The incidence rose to 27.3% in patients over age 50 weighing more than 75 kg (165 lb) and who had a pre-transplant random plasma glucose level greater than 5.5 mmol/L.

Additionally, higher mean pre-transplant random plasma glucose levels increased the risk by 54% and higher plasma glucose within the first seven days following transplantation in-creased the risk by 27%. The 10-year actuarial survival was 67.1% in pa-tients with new-onset diabetes versus 81.9% of those who didn’t develop it and 65.3% in patients known to have diabetes prior to transplantation.

The researchers observed no difference in graft survival between patients with and without diabetes. Ten-year graft survival was 76.7%, 69.3%, and 69.2% for patients who developed diabetes, those who had diabetes before transplantation, and those who had no diabetes, respectively.

“High-risk individuals should be identified and lifestyle advice given,” the authors concluded.

They added that tailoring of immunosuppression should be considered and the risk of development of new onset diabetes after transplantation should be weighed against the risk of acute rejection.