Majority of children experience abnormal glucose metabolism after kidney transplant: Study
Egypt: Research published in the journal Pediatric Nephrology showed that up to 71.4% of pediatric kidney transplant recipients (KTRs) experience abnormal glucose metabolism at some point in the first year. The peak onset of new-onset diabetes after transplantation (NODAT) was observed in the first month and impaired glucose tolerance (IGT) occurred with a peak from the first week and up to 6 months after KT.
The oral glucose tolerance test (OGTT) was shown to be a better tool than fasting plasma glucose (FPG) for monitoring glucose metabolism. An abnormal glycemic state was induced by tacrolimus and had an adverse effect on graft function.
Previous studies have shown high dynamicity of glucose metabolism after kidney transplantation with the first post-transplantation year being the most critical period for the occurrence of new-onset diabetes after transplantation. Doaa M. Salah, Pediatric Department, Faculty of Medicine, Cairo University, Cairo, Egypt, and colleagues, therefore, aimed to analyze the dynamics of glucose metabolism and report incidence/risk factors of abnormal glycemic state during the first year after KT in children.
For this purpose, the researchers assessed twenty-one consecutive freshly transplanted pediatric kidney transplant recipients for fasting plasma glucose and oral glucose tolerance test weekly for 4 weeks, then every 3 months for 1 year.
Salient findings of the study include:
- Interpretation of the OGTT test showed normal glucose tolerance (NGT) in 6 patients (28.6%) while 15 (71.4%) experienced impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) at any time point of monitoring.
- Seven patients had NODAT, for which three needed insulin therapy.
- Hyperglycemia onset was 7.8 ± 13.12 weeks (median = 1 week) after KT.
- Percent of patients with abnormal OGTT was significantly more than that of IFG (38.1% vs. 71.4%).
- Patients with the abnormal glycemic state had significantly elevated trough tacrolimus levels at 6 months.
- Glucose readings did not correlate with steroid doses nor rejection episodes while positively correlating with tacrolimus doses at 3 months and 6 months, and negatively correlating with simultaneous GFR at 9 months.
The researchers conclude, "abnormal glycemic state was seen in up to two-thirds of pediatric KTRs (71.4%) at some point with peak incidence within the first week up to 6 months after KT."
Reference:
Salah, D.M., Hafez, M., Fadel, F.I. et al. Monitoring of blood glucose after pediatric kidney transplantation: a longitudinal cohort study. Pediatr Nephrol (2022). https://doi.org/10.1007/s00467-022-05669-0
