Discussion On The Clinical Data Of Post Kidney Transplantation Diabetes Mellitus

Diabetes mellitus that evolves after solid organ transplantation(known as post-transplantation diabetes mellitus(PTDM))is a common complication after organ transplantation,which will increase the mortality and adverse outcome after organ transplantation.In 2003,the concept was first introduced in the guidelines for new onset diabetes after transplantation(NODAT)developed by an international committee of experts in the relevant field.In studies of other centers,PTDM occurred early after transplantation,usually 3 to 6 months postoperatively,with an average diagnostic time of 4.3 months and an cumulative 1-year incidence of 31.4%,most of which occurred within 6 months.This article followed 421 kidney transplantation recipients at Qilu Hospital between January 2012 and December 2018,11 kidney transplant recipients under the age of 18 years were excluded,28 recipients with pre-operative diagnoses of type 1 diabetes,type 2 diabetes or other specific types of diabetes were excluded,14 recipients with a previous history of kidney or other organ transplantation were excluded,and 25 renal transplant recipients whose follow-up time was less than 1 natural year were excluded.Through the statistical software IBM SPSS 25.0,343 kidney transplant recipients were divided into normal glucose group and PTDM group according to whether fasting blood glucose under 7.0mmol/L after 1 year of kidney transplantation,phase clinical data included age,sex,primary kidney disease,history of alcohol and tobacco use,body mass index,kidney donor status,pre-operative serum total cholesterol,pre-operative serum triglyceride,pre-operative serum low-density lipoprotein,pre-operative serum high-density lipoprotein,pre-operative fasting blood glucose,pre-operative fasting blood magnesium,pre-operative history of hepatitis,post-operative fasting blood glucose on day 1,3,7 after transplantation,post-operative infection,graft dysfunction or loss of graft-related complications,post-operative immunosuppression protocol.The results show that:1.The age distribution of the two groups with normal fasting blood glucose and abnormal blood glucose was different(p=0.024).The risk of abnormal fasting blood glucose after kidney transplantation was higher in the older group.2.The distribution of body mass index(BMI)was different between normal fasting blood glucose group and abnormal blood glucose group(p=0.001).The higher BMI was,the higher risk of abnormal fasting blood glucose was.3.The distribution of serum triglyceride was different between normal fasting blood glucose group and abnormal blood glucose group(p=0.036).The risk of abnormal fasting blood glucose after kidney transplantation was higher in patients with higher serum triglyceride level.4.The distribution of serum high-density lipoprotein cholesterol was different between normal fasting blood glucose group and abnormal blood glucose group(p=0.002).The risk of abnormal fasting blood glucose after kidney transplantation was higher in patients with higher serum high-density lipoprotein cholesterol level.5.The proportion of donor kidney source was different between normal fasting blood glucose group and abnormal blood glucose group(P=0.016).The risk of abnormal fasting blood glucose was higher in cadaveric kidney transplant recipients.6.The proportion of immunosuppressive regimen was different between normal fasting blood glucose group and abnormal blood glucose group(p=0.009).The risk of abnormal fasting blood glucose after kidney transplantation was higher when tacrolimus was used as immunosuppressive regimen.7.BMI significantly influenced the outcome of follow-up blood glucose(p=0.013<0.05).For every increase in BMI,the risk of post transplantation diabetes mellitus increased 1.115-fold one year after surgery.HDL also significantly influenced the outcome of follow-up blood glucose(p=0.012<0.05).For 1mmol/L decrease in HDL,the risk of post transplantation diabetes mellitus was reduced by 17.7%.8.Fasting glucose levels at day 3 and day 7 postoperatively were of diagnostic value for follow-up glucose outcome.The ROC curve was 0.672(95%CI 0.583-0.761)and 0.649(95%CI 0.570-0.728),respectively.The ROC curve was used to evaluate the diagnostic value of fasting blood glucose immediately after operation.The best cut-off point of fasting blood glucose level on the 3rd day after operation was 7.740 mmol/L,the sensitivity was 59.3%,the specificity was 74.4%,and the Yoden index was 0.336 On the 7th day after operation,the best cut-off point of fasting blood glucose was 5.235 mmol/L,the sensitivity was 73.1%,the specificity was 45.8%,and the Yoden index was 0.273.Conclusion:1.Before kidney transplantation,patients with advanced age,body mass index,high preoperative serum triglyceride level,low preoperative serum high-density lipoprotein cholesterol level,cadaveric donor kidney,and use of tacrolimus instead of cyclosporine as immunosuppressive regimen were high risk factors for postoperative fasting glucose abnormalities.2.BMI significantly influenced the outcome of follow-up blood glucose(p=0.013<0.05).For every increase in BMI,the risk of post-transplant diabetes increased 1.115-fold one year after surgery.HDL also significantly influenced the outcome of follow-up blood glucose(p=0.012<0.05),the risk of developing post transplant diabetes was reduced by 17.7%at 1 year postoperatively.3.The fasting blood glucose level in perioperative period(1 day,3 days and 7 days after operation)has diagnostic value for whether the fasting blood glucose level is normal or not one year after operation.The optimal cut-off point of fasting blood glucose level on the 3rd day after operation is 7.740 mmol/L,the optimal cut-off point of fasting blood glucose was 5.235 mmol/L on the 7th day after operation.