| Objective: New diabetes mellitus is a common serious complication after solid organ transplantation.Compared with patients without diabetes,kidney transplant recipients with posttransplant diabetes mellitus(PTDM)had an increased risk of fatal and non-fatal cardiovascular events and other adverse outcomes,including infection,decreased patient survival,graft rejection,and accelerated graft injury.Identifying high-risk patients and taking measures to reduce the development of PTDM may improve the long-term prognosis of patients and grafts.The purpose of this research was to study the influencing factors of different blood glucose outcomes in patients with hyperglycemia after kidney transplantation,so as to provide theoretical support for the prevention of diabetes after kidney transplantation.Methods: A total of 549 kidney transplant patients in the affiliated hospital of Qingdao university from 2013 to 2018 were collected and followed up for 1.5 years.According to the changes of fasting blood glucose after the operation,178 patients with abnormal glucose metabolism after the stabilization of blood glucose after kidney transplantation were selected.According to whether the fasting blood glucose returned to normal after the operation,68 cases were divided into the transient diabetes group and 110 cases were divided into the post-transplant diabetes group.Collection of two groups of patients with gender,age,height,weight,BMI,systolic pressure,diastolic blood pressure,family history of diabetes,polycystic kidney,preoperative fasting plasma glucose,triglyceride(TG),total cholesterol(CHOL),high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),acute rejection,history of hepatitis b virus(HBV)infection,hepatitis C virus(HCV)infection history,history of EB virus infection,history of cytomegalovirus(CMV)infection.Due to the existence of many independent variables,univariate analysis is preferred for all independent variables to screen out meaningful independent variables,and then the selected independent variables are subject to multivariate Logistic regression analysis to analyze the influencing factors of PTDM.A total of 58 patients with abnormal glucose metabolism after kidney transplantation who met the inclusion criteria were followed up,and a total of 40 patients who eventually developed diabetes were assigned to the PTDM group and 18 patients with blood glucose recovery were assigned to the transient PTDM group.Fasting blood glucose,fasting c-peptide,and fasting insulin concentrations of the two groups were monitored,and homeostasis model(HOMA)was used to evaluate the islet cytoplasmic function(HOMA-HBCI)and insulin resistance(HOMA-IR)of the two groups,and the differences in fasting c-peptide concentration,fasting insulin concentration,HOMA-IRand HOMA-HBCI between the two groups were compared.Results: Among the 549 renal transplant patients,178 patients showed abnormal glucose metabolism after transplantation,the incidence rate was 32.4%,among which 68 patients showed normal blood glucose,the incidence rate was 12.4%,and 110 patients developed post-transplantation diabetes,the incidence rate was 20%.Univariate analysis results showed that age,BMI,preoperative fasting blood glucose,acute rejection,polycystic kidney disease,and family history of diabetes were all higher in the post-transplant diabetes group than in the transient diabetes group(P<0.05).Multivariate Logistic regression analysis showed that age,preoperative fasting blood glucose,acute rejection,polycystic kidney disease,and family history of diabetes mellitus were influential factors for the failure to recover from hyperglycemia after kidney transplantation.The concentration of fasting c-peptide and fasting insulin in PTDM group was lower than that in transient PTDM group(P<0.05),and HOMA-HBCI in PTDM group was lower than that in transient PTDM group(P<0.05).There was no statistical difference in HOMA-IR between the two groups.Conclusion: The incidence of diabetes in 1.5 years after kidney transplantation was 20%,and that of transient diabetes was 12.4%.The difficulty in recovering from hyperglycemia after kidney transplantation is the result of multiple factors.Age,preoperative fasting blood glucose,acute rejection,polycystic kidney disease,and family history of diabetes mellitus are the influencing factors for blood glucose recovery in patients with abnormal glucose metabolism after kidney transplantation.Insufficient insulin secretion is the pathogenesis of abnormal glucose metabolism after renal transplantation,which is difficult to recover.There is no correlation between insulin resistance and the recovery of hyperglycemia after transplantation. |
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