Increasing risk factors of new-onset diabetes mellitus after transplantation in pediatric renal transplant recipients

Aim: New-onset diabetes mellitus after transplantation (NODAT) is a major complication of kidney transplant. The aim of this study was to evaluate the incidence and associated factors of NODAT among kidney transplant recipients in a single center. Material and Method: Between May 1994 and July 2018, 138 patients 1- 19 years of age who underwent renal transplantation in Ege University Medical Faculty Pediatric Nephrology Clinic were evaluated retrospectively. Patients who had no previous diagnosis of diabetes mellitus and had a follow-up of at least 6 months were included in the study. Risk factors reported in the literature were investigated and data on demographic, anthropometric and laboratory parameters were recorded. Patients were divided into two groups: With and without NODAT – for statistical comparison. Result: A total of 145 patients with renal transplantation during the study, of them 138 kidney transplant recipients were included in the analysis. The incidence of NODAT was 9.4% (n = 13). In the NODAT group, female gender was 84%, mean age was 13.9 ± 2.5 years, and the rate of transplantation from cadaver donor was 84%. The median time of NODAT diagnosis was 60 (10-750) days after transplantation. Nine (69%) of these patients were diagnosed within the first 6 months. In the non-NODAT group (n = 125), female gender was 42.9%, mean age was 11.2 ± 4.3 years and transplantation from cadaver donor was 46.4%. A statistically significant difference was found between the two groups in terms of female gender and cadaver donor transplantation (p = 0.004, p = 0.009, respectively). Male donor gender, age of 13 years and older, and history of peritoneal dialysis were higher frequent in the NODAT group, but there was no statistically significant difference between the two groups. Patients receiving cyclosporine (3.3%) had a lower incidence of NODAT than patients receiving tacrolimus (14.1%). When the gender of the recipient was examined, it was found to be 6.7 times greater risk for the development of NODAT than boys (p = 0.013). According to donor type, cadaver donor was found to be 5.6 times greater risk than living donor (p = 0.024). According to the average blood level of tacrolimus during the first year, as the blood level of the drug increased, the risk of developing NODAT increased by 1.34 times (p = 0.02), according to the mean tacrolimus blood level during the second year, the risk increased by 1.37 times as the drug blood level increased (p = 0.02). Conclusion: The incidence of NODAT was high in our pediatric kidney transplant recipients, especially in the first 6 months after transplantation. Female gender, cadaver donor transplantation and high tacrolimus blood level were risk factors. The choice of immunosuppressive therapy was the only modifiable risk factors reaching significance. Close monitoring and modified protocols can help minimize the side effects of tacrolimus. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.