Débora Dias de Lucena,1 João Roberto de Sá,2 José O. Medina-Pestana,1
and Érika Bevilaqua Rangel 1,3
1Nephrology Division, Universidade Federal de São Paulo/Hospital do Rim, São Paulo, SP, Brazil
2Endocrinology Division, Universidade Federal de São Paulo, São Paulo, SP, Brazil
3Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
Modifiable and nonmodifiable risk factors for developing posttransplant diabetes mellitus (PTDM) have already been established in
kidney transplant setting and impact adversely both patient and allograft survival. We analysed 450 recipients of living and
deceased donor kidney transplants using current immunosuppressive regimen in the modern era and verified PTDM prevalence
and risk factors over three-year posttransplant. Tacrolimus (85%), prednisone (100%), and mycophenolate (53%) were the main
immunosuppressive regimen. Sixty-one recipients (13.5%) developed PTDM and remained in this condition throughout the
study, whereas 74 (16.5%) recipients developed altered fasting glucose over time. Univariate analyses demonstrated that
recipient age (46:2 ± 1:3 vs. 40:7 ± 0:6 years old, OR 1.04; P = 0:001) and pretransplant hyperglycaemia and BMI ≥ 25 kg/m2
(32.8% vs. 21.6%, OR 0.54; P = 0:032 and 57.4% vs. 27.7%, OR 3.5; P < 0:0001, respectively) were the pretransplant variables
associated with PTDM. Posttransplant transient hyperglycaemia (86.8%. 18.5%, OR 0.03; P = 0:0001), acute rejection (P = 0:021),
calcium channel blockers (P = 0:014), TG/HDL (triglyceride/high-density lipoprotein cholesterol) ratio ≥ 3:5 at 1 year (P = 0:01)
and at 3 years (P = 0:0001), and tacrolimus trough levels at months 1, 3, and 6 were equally predictors of PTDM. In multivariate
analyses, pretransplant hyperglycaemia (P = 0:035), pretransplantBMI ≥ 25 kg/m2 (P = 0:0001), posttransplant transient
hyperglycaemia (P = 0:0001), and TG/HDLratio ≥ 3:5 at 3-year posttransplant (P = 0:003) were associated with PTDM diagnosis
and maintenance over time. Early identification of risk factors associated with increased insulin resistance and decreased insulin
secretion, such as pretransplant hyperglycaemia and overweight, posttransplant transient hyperglycaemia, tacrolimus trough levels,
and TG/HDL ratio may be useful for risk stratification of patients to determine appropriate strategies to reduce PTDM.