Abstract
Background
Understanding the relative contributions of baseline demographics and immunosuppressive therapy on NODAT risk may help in developing preventive strategies.
Methods
Using our prospectively followed cohort of 481 adult, primary kidney transplant recipients without pre‐transplant diabetes, we determined the significant baseline predictors for the hazard rate of developing NODAT via Cox stepwise regression. The multivariable influence of first BPAR (defined as a time‐dependent covariate) was also tested.
Results
Median follow‐up was 57 mo post‐transplant; the overall percentage who developed NODAT was 22.5% (108/481). Four baseline predictors of a greater NODAT hazard rate were found (by order of selection): higher BMI (p < 0.000001), planned maintenance with SRL (p = 0.0003), non‐white recipient (p = 0.0004), and older recipient age (p = 0.0004). Approximately one‐half of the 106 patients in the highest demographic risk category (BMI ≥25 kg/m2, non‐white race, and age at transplant ≥40 yr) developed NODAT; actuarial NODAT risk ranged from 10% to 30% in the lower demographic risk categories. First BPAR was also associated with significantly higher NODAT in multivariable analysis (p = 0.02)—the highly elevated NODAT rate observed during the first few months post‐transplant and following first BPAR appears to demonstrate the diabetogenic effect of using high‐dose (intravenous) corticosteroids.
Conclusions
The disturbingly high NODAT rate found among patients having multiple demographic risk factors is still an important problem that awaits a better solution.
