Prevalence and Risk Factors for New Onset Diabetes Mellitus after Renal Transplantation

Archana, B M (2016) Prevalence and Risk Factors for New Onset Diabetes Mellitus after Renal Transplantation. Doctoral thesis, Stanley Medical College, Chennai.

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Abstract

BACKGROUND: In an era where successful renal transplantation can be offered to a growing number of patients, there is an increasing concern about the complications that develop after the transplantation of a functioning allograft. One of the most significant complications in this setting is new-onset diabetes after transplantation (NODAT) as it is the major factor leading to dysfunction of the renal graft and patient death and is a risk factor for cardiovascular disease in these patients. The mechanism behind the development of NODAT is poorly understood and is possible that a similar pathogenesis occurs to that of Type 2 diabetes, but differs in being partially reversible because of the associated immunosuppressive medication. There are various risk factors contributing to NODAT and are categorized into Non modifiable, Potentially modifiable and modifiable. The incidences of infections were reported to be high in patients with NODAT. AIMS AND OBJECTIVES: To study the prevalence of NODAT among the patients who underwent renal transplantation and to assess the relevant risk factors contributing to the pathogenesis of NODAT. And also to study the complications that develop in patients diagnosed with NODAT and the difference in pattern of NODAT between live related and deceased donor transplant recipients. MATERIALS AND METHODS: The study was carried out by retrospective analysis of the data of patients who underwent renal transplantation in Stanley medical college from January 2012 to December 2014. The following data : Smoking history, family history of Diabetes, native kidney disease, type of Dialysis, duration of Dialysis, Hep-B virus infection, Hep-C virus infection, CMV infection, fasting blood sugar, serum total cholesterol, serum triglyceride, urine routine, graft type, induction therapy, recovery of graft function, acute rejection history, immunosuppressant regimen, type of complications were analysed. RESULTS: Out of 115 patients studied, 26 patients developed NODAT which accounts to a prevalence of 22.6%. 20 patients developed NODAT within a year following transplantation. The mean age of the patients who developed NODAT was 35.23 years. Majority of the patients who underwent renal transplantation were males. Native kidney disease was not known in majority of the subjects and most of the patients were on hemodialysis. 3 patients who were positive for CMV developed NODAT. Most of the patients underwent live related renal transplantation. Older age, positive smoking history, family history of diabetes, acute rejection history, post transplant blood sugar levels, dose of Tacrolimus and prednisilone used as a part of immunosuppressive regimen were found to be significant associated with NODAT. Both community acquired and opportunistic infection rates were high in NODAT patients compared with N-NODAT patients. CONCLUSIONS: The prevalence of NODAT in our setup was 22.6%. Older age, positive smoking history, family history of diabetes, acute rejection history, post transplant blood sugar levels, dose of Tacrolimus and prednisilone used were all concluded to be significant risk factors contributing to the pathogenesis of NODAT. The pattern of NODAT was not different whether the transplant is live related or deceased donor. Bacterial pneumonia, CMV infections and fungal infections were common in patients with NODAT. Hence modification of certain modifiable risk factors can decrease the incidence of NODAT and also individuals at increased risk can be identified and screened earlier and managed appropriately.

Item Type: Thesis (Doctoral)
Uncontrolled Keywords: NODAT, N-NODAT, Hepatitis c infection, cytomegalovirus (CMV).
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 29 Dec 2017 17:34
Last Modified: 01 Apr 2021 03:03
URI: http://repository-tnmgrmu.ac.in/id/eprint/4929

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