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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR Table of Contents   
Year : 1995  |  Volume : 6  |  Issue : 3  |  Page : 315-316
Diabetes Mellitus after Kidney Transplantation


Department of Nephrology, King Hussein Medical Center, Amman, Jordan

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How to cite this article:
Al-Akash N. Diabetes Mellitus after Kidney Transplantation. Saudi J Kidney Dis Transpl 1995;6:315-6

How to cite this URL:
Al-Akash N. Diabetes Mellitus after Kidney Transplantation. Saudi J Kidney Dis Transpl [serial online] 1995 [cited 2020 Jun 5];6:315-6. Available from: http://www.sjkdt.org/text.asp?1995/6/3/315/40670
To the Editor:

Several metabolic disturbances that may contribute to long-term morbidity and mort­ality occur with increased frequency after renal transplantation. The cause of these disorders is usually multi-factorial resulting from an interaction of inherent genetic susceptibility, effect of immunosuppressant and antihypertensive drugs as well as weight gain [1] .

We studied 100 patients who underwent renal transplantation at King Hussein Medical Center, Amman, Jordan between January 1987 and June 1993 in order to investigate the prevalence of diabetes mellitus (DM) that develops in patients after receiving renal transplantation and also to assess its risk factors and complications.

There were 82 males (82%) and 18 females (18%) in the study and their follow-up period ranged from 12 to 82 months. None of the study patients were known to have DM in the past. All patients were on triple immunosuppressive therapy with predni­solone (initial dose, 60 mg daily; maintenance dose, 10 mg daily by the 12th week), azathioporine (1-3 mg/kg body weight daily) and cyclosporin-A (4-6 mg/kg body weight daily according to serum trough levels). The diagnosis of post-transplant diabetes mellitus (PTDM) was made upon demon­strating a fasting blood sugar of > 7.8 mmol/L on at least two occasions. Based on this criterion, 15 patients developed PTDM giving a prevalence rate of 15%. This is in accordance with other studies where the reported prevalence rates of PTDM have varied from 5% to 45% [2] . Ten of the 15 patients in our study (66.6%) developed DM within the first three months following transplantation while the remaining five (33.4%) developed DM, within six months. Eleven of these patients (73%) presented with asymptomatic elevation of fasting blood sugar levels detected on routine screening while four others presented with polyuria and polydipsia. Nine patients required oral hypoglycemic agents while the other six needed insulin for glycemic control. In four patients who were on frusemide, the dose requirement of oral hypoglycemic agents became lower upon discontinuation of this drug.

We found a higher prevalence of infection in the PTDM patients with eight patients (53%) developing infection (two, urinary tract infection; one, pneumonia; one, wound infection; two, herpes zoster and two, fungal infections). This was in contrast to the non­DM group of whom only 20% developed infection. Renal function tests as expressed by serum creatinine and incidence of allograft rejection were similar to the non­DM group. There was no significant difference in the graft and patient survival rates at one year between the two groups: graft survival of 87% and 89%; and patient survival of 93% and 95% in PTDM and non-PTDM patients respectively.

The mean age of the patients was higher and the percentage of body weight increment in the first year post-transplant, was greater in the PTDM patients (43 years and 28% respectively) when compared to the non­PTDM patients (32 years and 10% respect­ively). This is in accordance with other reports that the age of the patients and the percentage increase in body weight contri­bute significantly to the development of PTDM [3] .

Post-transplant diabetes mellitus is also attributed to steroids and cyclosprin [4],[5] . Steroids have a two fold effect on glucose metabolism namely, altering insulin secretion by the pancreatic beta cells and producing insulin resistance by as yet undefined post­receptor effect [4],[5] . Cyclosporin is believed to have a direct toxic effect on pancreatic beta cells [6],[7] while a reversible suppression of insulin release has also been documented [8] . Since all our study patients were on both these drugs, their individual role in the causation of PTDM could not be deter­mined. In conclusion, the prevalence of PTDM was 15% in our renal transplant patients, and it manifested most commonly in the first three months after transplantation. It was more common in the patients olderthan 40 years of age and in patients whose body weight gain was greater in the first year after transplantation. It was associated with higher incidence of infections but did not affect patient and graft survival.

 
   References Top

1.Markell MS, Armenti V, Danovitch G, Sumrani N. Hyperlipidemia and glucose intolerance in the post-renal transplant patient. J Am Soc Nephrol 1994;4:S37-47.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Rao M, Jacob CK, Shastry JC. Post-renal ransplant diabetes mellitus- a retrospective study. Nephrol Dial Transplant 1992;7(10):1039-42.  Back to cited text no. 2    
3.Munch A. Glucocorticoid inhibition of glucose uptake by peripheral tissues old and new evidence, molecular mechanisms and physiological significance. Perpect Biol Med 1971;14:265-9.  Back to cited text no. 3    
4.Rizz MA, Mandarino LJ, Gerich JE. Cortisol induced insulin resistance in man. J Clin Endocrinol Metabolism 1982;54:131-8.  Back to cited text no. 4    
5.Dresner LS, Andersen DK, Kahng KU, Munshi IA, Wait RB. Effects of cyclosporine on glucose metabolism. Surgery 1989;106:163-9.  Back to cited text no. 5  [PUBMED]  
6.Hahn HJ, Laube F, Lucke S, Kloting I, Kohnert KD, Warzock R. Toxic effects of cyclosporine on the endocrine pancreas of Wistar rats. Transplantation 1986;41:44-7.  Back to cited text no. 6    
7.van Schilfgaarde R, van der Burg MP, van Suylichem PT, et al. Reversible suppression of canine beta cell function by cyclosporine A is dose dependent. Transplant Proc 1986;19:1556.  Back to cited text no. 7    
8.Yoshimura N, Nakai I, Ohmori Y, et al. Effect of cyclosporine on the endocrine and exocrine pancreas in kidney transplant recipients. Am J Kidney Dis 1988;12:11-7.  Back to cited text no. 8  [PUBMED]  

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Correspondence Address:
Nabil Al-Akash
Department of Nephrology, King Hussein Medical Center, P.O. Box 960955, Amman
Jordan
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PMID: 18583743

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