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首页> 外文期刊>South African medical journal = >New-onset diabetes after transplant: Incidence, risk factors and outcome
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New-onset diabetes after transplant: Incidence, risk factors and outcome

机译：移植后新发糖尿病：发病率，危险因素和结果

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BACKGROUND. The outcome of renal transplantation depends on achieving effective immunosuppression while minimising the consequences of such treatment. The occurrence of new-onset diabetes in the post-transplant period has been associated with several risk factors including some immunosuppressive medication. Better understanding of the clinical and genetic risk factors associated with new-onset diabetes after transplant (NODAT) could enable risk stratification of patients in the pre-transplant period, with the goal of applying measures that will reduce the incidence. OBJECTIVES. To ascertain the incidence of and clinical and genetic risk factors that predispose to NODAT, and to examine its effect on the outcome of renal transplantation. METHODS. We performed a retrospective cohort review of all renal transplants at Groote Schuur Hospital, Cape Town, South Africa, between 2004 and 2008. Patients who were lost to follow-up or had pre-transplant diabetes or primary non-function were excluded. A subset of the cohort who gave informed consent was enlisted for genetic tests. RESULTS. We identified 111 patients who met the inclusion criteria. The incidence of NODAT was 18.0% (n=20 patients). Risk factors for NODAT included age at transplant (p=0.03), body weight (p=0.04), treatment for acute cellular rejection (p=0.02) and polycystic kidney disease as the cause of renal failure (p=0.005). None of the genes investigated (TCF7L2 rs11196205, rs12255372 and rs7903146 and HNFl? rs1800575, rs121918671 and rs121918672) was found to be significantly associated with the risk of NODAT. The genotype frequencies for the single-nucleotide polymorphisms studied were closer (although not identical) to those reported for Caucasians than to those reported for the Yoruba (black) population in West Africa. Overall patient survival was 78% at five years, while graft survival was 72%. There was no significant difference in patient or graft survival between the group with NODAT and the group without. CONCLUSIONS. NODAT was common in renal transplant recipients. Some risk factors predate transplant and could be used to risk-stratify patients to determine appropriate risk-reduction strategies. The genetic determinants for NODAT in this population may differ from those reported elsewhere. NODAT had no impact on patient or graft survival in this cohort.
机译：背景。肾移植的结果取决于实现有效的免疫抑制，同时最大程度地减少此类治疗的后果。移植后新发糖尿病的发生与一些危险因素有关，包括一些免疫抑制药物。更好地了解与移植后新发糖尿病相关的临床和遗传危险因素（NODAT）可以在移植前期对患者进行危险分层，其目的是采取可降低发病率的措施。目标确定易患NODAT的发生率以及临床和遗传危险因素，并检查其对肾移植结局的影响。方法。我们对2004年至2008年之间在南非开普敦的Groote Schuur医院的所有肾移植进行了回顾性队列研究。排除了失访或患有移植前糖尿病或原发性无功能的患者。征得知情同意的队列中的一部分参加了基因检测。结果。我们确定了111位符合纳入标准的患者。 NODAT的发生率为18.0％（n = 20例）。 NODAT的危险因素包括移植时的年龄（p = 0.03），体重（p = 0.04），急性细胞排斥反应的治疗（p = 0.02）和多囊性肾病作为肾衰竭的原因（p = 0.005）。没有发现被调查的基因（TCF7L2 rs11196205，rs12255372和rs7903146和HNF1？rs1800575，rs121918671和rs121918672）与NODAT的风险显着相关。研究的单核苷酸多态性的基因型频率与白种人报告的基因型频率相近（尽管不完全相同），而与西非约鲁巴（黑人）人群的基因型频率相近。五年时患者总生存率为78％，而移植物生存率为72％。有NODAT组和无NODAT组之间的患者或移植物存活率无显着差异。结论。 NODAT在肾移植患者中很常见。一些危险因素早于移植，可用于对患者进行风险分层以确定适当的降低风险策略。该人群中NODAT的遗传决定因素可能与其他地方报道的不同。在这一队列中，NODAT对患者或移植物的存活没有影响。

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