Impact of Post-Transplant Dysglycemia on Renal Allogrfat Function in Kidney Transplant Recipients on Cyclosporine-Based Immunosuppression

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Abstract

Introduction. Post-transplant diabetes (PTDM), impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are common complications of immunosuppressive therapy (IT) and are associated with increased cardiovascular morbidity and impaired graft function (GF).

Methods. Fifty-nine living donor kidney transplant recipients (KTR) were included in a combined cross-sectional and 8-month-observational prospective study about the impact of impaired glucose homeostasis (IGH) on GF. All patients were on standard IT including cyclosporine A (CsA), steroids and mycophenolate mofetil (MMF). In all patients a standard oral glucose tolerans test (OGTT) was performed. Results were classified according to the criteria of the American Diabetes Association: normal-with fasting blood glucose level (FGL) <5.6, IFG with FGL of 5.6-6.9, IGT with FGL of 7.8-11.1 and DM between > 6.9 FGL and >11 mmol/l. According to the results, all patients were divaded into two groups: Group 1 with impaired and Group 2 with normal GH. GF was estimated by GFR-Cockroft Gault (CG) and by degree of proteinuria in the beginning and end of the study.

Results. Twenty of 59(33.9%) patients showed overt IGH after transplantation while the remaining 39(66.1) were normal. The principal dysglycemia in KTR were PTDM (2 patients-3.3%), IGT (18 patients-30.5%) and IFG (7 patients-11.8%). In Group 1, postprandial glucose was higher (8.1±2.3 vs 5.8±0.7), more KTR were male (70% vs 33.3%), higher CsA levels were observed (160.9±81.2 vs 115.1±59.9) and time after the surgery was shorter (24.5±21.3 vs 41.4±28.). After a follow-up period of approximately 18 months in Group 1 a significant decline in GFR (62.6-52.7 ml/min) was noted, with no significant change in proteinuria. The correlation analysis was positive between CsA level and IGH and the time after transplantation and IFG.

Conclusion. Post-transplant dysglycemia and associated metabolic abnormalities are a significant factor for the deterioration of GF. CsA higher levels are associated with the occurrence of IGH and they affect the GF.

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