Evaluation of microvascular complications of post-transplantation diabetes mellitus in kidney transplant recipient patients

Evaluation of Microvascular Complications of post-transplantation Diabetes Mellitus in Kidney Transplant Recipient Patients, Hacettepe University, Internal Medicine Department, Phd Thesis, Ankara, 2022. Throughout years, organ transplantation procedures have been increased. Thus, new treatment modalities after organ transplantation have been developed. By the help of this new treatment modalities, primary transplantation related mortality rates of transplant recipient patients have been declined over the years; however, the increasing rate of metabolic diseases after organ transplantation is striking fact in current medical practice. Post-transplantation Diabetes Mellitus (PTDM) is one of the important metabolic diseases that patients encountered over years. This study aims the evaluation of the microvascular complications of diabetes mellitus which is developed after renal transplantation in kidney-recipient patients. To determined cohort study and control groups, we reviewed patients who had renal transplantation surgery in Hacettepe University Hospital from 1985 to 2017. In total 771 patients were found as a renal transplant recipient; 44 patients who had diabetes mellitus more than 5 years after kidney transplantation, were accepted as PTDM cohort study group and 39 patients who didn't have PTDM, were accepted as control group. Diabetic retinopathy was evaluated by ophthalmologist with ocular fundus photography and optical coherence tomography (OCT). Diabetic nephropathy was evaluated with a spot urine albumin creatinine ratio and a glomerular filtration rate (GFR). Peripherical diabetic neuropathy evaluated with Michigan Neuropathy Screening Instrument (MNSI) test. Feet inspection and bilateral ankle jerk reflex measurement were done by the same doctor in patients' examinations. Amputation risk was assessed with 10-gram monofilament test. The quantitative measurement of tactile and vibration senses was calculated by using CASE-IV device. Corneal confocal microscopy, which is used in the early diagnosis of diabetic neuropathy was applied. Cardiac autonomic neuropathy was assessed by using ELA Medical SpiderView Holter Device with 24 hours cardiac recording. We found out that 20.5% PTDM patients had diabetic peripheral neuropathy as the result of MNSI test. Corneal nerve fiber density (CNFD) measured by corneal confocal microscopy (CCM) is significantly lower in the PTDM cohort group and especially the subgroup of PTDM patients who had diabetic neuropathy. More than the half of the PTDM cohort groups and approximately 20% of control group were affected by cardiac autonomic neuropathy. No significant differences were found in GFR measurement and the pot urine albumin creatinine ratio between two groups. In PTDM group, 20.5% patients were diagnosed diabetic retinopathy as a result of ocular fundus photography and OCT. Corneal retinal fiber density decrement was similar between two groups in CCM measurement. In conclusion, diabetic microvascular complications in organ transplant recipient patients can be seen with unique features when we compare it with Type 1 and Type 2 Diabetes Mellitus microvascular complications. Emerging microvascular complications may cause morbidity and mortality in renal transplant patients. İn order to prevent this, screening modalities of microvasculer complications seen in the course of PTDM should be established. Key Words: Posttransplant Diabetes Mellitus (PTDM, New Onset Diabetes After Transplantation (NODAT), diabetic retinopathy, diabetic nephropathy, diabetic peripheral sensory neuropathy, corneal confocal microscopy, cardiac autonomic neuropathy