J SINGER1,2, DR LEYLA AOUAD1,2, D GRACEY1,2, K WYBURN1,2, T YING1,2, S CHADBAN1,2
1Department of Renal Medicine, Royal Prince Alfred Hospital, Sydney, Australia, 2Kidney Node, Charles Perkins Centre, The University of Sydney, Australia
Aim: To investigate the utility of pre-transplant oral glucose tolerance tests (OGTT) in identifying individuals at risk for the development of new-onset diabetes (NODAT) following a kidney transplant.
Background: NODAT occurs commonly in kidney transplant recipients (KTRs) and is associated with an increase in recipient morbidity and mortality. Early identification of patients at risk for NODAT is the first step in implementing strategies to mitigate its development and to inform clinicians and patients of their medical risk. Pre-transplant OGTT has been suggested by the KDIGO 2020 Guidelines for this purpose.
Methods: In this single-centre cohort study, we examined the electronic medical records of all non-diabetic KTRs between 2003 and 2018. We identified 443 KTRs who had both a pre-transplant OGTT and post-transplant determination of glycaemic status by either a clinical diagnosis of NODAT or a post-transplant OGTT beyond week 10. Deterministic record linkage was used to obtain recipient factors, transplant characteristics, and patient outcomes from the ANZDATA registry.
Results: Pre-transplant dysglycaemia (impaired glucose tolerance (IGT) and/or impaired fasting glucose (IFG)) was identified in 28% of KTRs. Dysglycaemic patients were older (P<0.001), had a higher BMI (P=0.03) and were more commonly undergoing peritoneal dialysis (P<0.001). Following transplant, 144 patients (24%) developed NODAT and a further 121 (20%) displayed IGT. In multivariate analysis, greater age (OR 1.04, P < 0.001) and a pre-transplant history of IGT (OR 3.05, P < 0.001) were significantly associated with the development of NODAT.
Conclusions: Pre-transplant OGTTs identify patients at risk for the development of NODAT. Robust prospective trials are needed to determine whether various interventions, including choice of immunosuppression, alters the development of NODAT and ultimately outcomes, in at-risk KTRs.
Dr Julian Singer is a clinician/scientist. In 2018 he was awarded the University of Sydney Postgraduate Research Scholarship in Renal Medicine and has since been undertaking doctoral studies in the Kidney Node Laboratory, Charles Perkins Centre, under the stewardship of Professor Steven Chadban and A/Prof Huiling Wu. Dr Singer’s current research focuses on investigating the molecular mechanisms of transplant rejection, examining the role of the gut microbiota in modulating host immunity, and improving outcomes for kidney transplant recipients.