New Onset Diabetes After Kidnet Transplantation Despite the Use of a Steroid-Sparing Regime Is Associated With a Higher Mortality From Cardiac Causes.

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Purpose New-onset diabetes after transplantation [NODAT] is associated with increased cardiovascular risk and reduced patient survival. We have also shown that patients who develop NODAT, despite the use of a steroid sparing immunosuppressive regime have reduced patient survival. In this study, we investigate the causes of death in these patients developing NODAT. Methods In a retrospective, single centre study, we report the outcomes of 920 patients [552m, 368f, mean age 47±13.3 yrs, range 18-78, mean follow up 57.6±30 mths], receiving a steroid sparing, tacrolimus based regime after monoclonal antibody induction. Steroids were stopped 7 days post kidney transplantation and only reintroduced to treat rejection. We excluded patients with history of diabetes mellitus. Results Overall, 169/920 [18.4%] patients developed NODAT, defined as diabetes requiring diet control [19.9%], oral hypoglycaemics [62.0%], insulin [15.7%] or both [2.4%]. Cumulative patient survival in the NODAT+ and NODAT- groups at 1, 3, 5 years post transplant was 98.2%, 93.6%, 90.2% and 98.5%, 97%, 94.8%, respectively (p=0.032). Cumulative graft survival in the NODAT+ and NODAT- groups at 1,3 and 5 years was 98.2%, 92.3%, 87% and 95.7%, 92%, 87.9%, respectively (p=0.547). The cumulative incidence of NODAT was 9.5%, 14.2% and 16.5% at 1, 3 and 5 years after transplantation, respectively. During follow up, there were 71 cardiac events, 22 of which occurred in patients with NODAT [1 STEMI, 9 non-STEMIs, 9 episodes of cardiac arrhythmia and 3 cardiac deaths]. In NODAT- patients, there were 49 cardiac events (4 STEMI, 18 NSTEMI, 24 episodes of cardiac arrhythmia and 3 cardiac deaths). The NODAT+ group had an increased risk of cardiac events (12.4% vs. 6.5%, p=0.009) and death (10.1% vs. 4.9%, p=0.011). Patients with NODAT had reduced coronary event-free survival (log rank p=0.017) and overall survival (log rank p=0.032). Older age (p<0.001) and development of NODAT (p=0.041) increased the risk for a cardiac event. Conclusions This study shows that patients who develop NODAT despite the use of a steroid-sparing regime have a higher incidence of cardiac events and impaired patient survival.

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