Correlation Between Human Leukocyte Antigen And Post-transplantation Diabetes Mellitus Of Han Population In Hunan And Parts Of Jiangxi Province

OBJECTIVE1. To identify the susceptible genes and protective genes of PTDM in south China, and provide guidances for clinical individualized drug administration.2. To find out if Cyclosporine A (CsA) or Tacrolimus (Tac) based immunosuppressive regimens lead to different onset risks of PTDM under the principle of "Low dosage of Drugs and Monitored Low Concentration in Blood".3. To demonstrate the incidence of PTDM in different age groups, and find out if old age plays a role in the pathogenesis of PTDM.METHODSFrom 2003 to 2008, Several hundreds of patients accepted kidney transplantation in our center, their personal information, clinical examination results and HLA phenotypes were collected, all patients were followed up as possible as we could, 195 patients with complete data were enrolled in our study. Among the 195 patients, there were 22 patients in PTDM group, 173 patients in non-PTDM group, we compared the frequency of each HLA phenotypes between the PTDM and non-PTDM groups with chi-square test; The 195 patients were divided into CsA group and Tac group according to the characteristics of immunosuppressive regimen, we compared the incidence of PTDM of the two groups with chi-square test; All the patients were then divided into elderly group (age≥40) and low-age group (age< 40), the incidences of PTDM were calculated and compared between the two groups with chi-square test.RESULTS①HLA-A30 and HLA-DR7 maybe the susceptible genes of PTDM in Hunan and parts of Jiangxi province, no protective gene was found in our study;②Low dosage of CNIs drugs were applied to prevent rejection, the drug concentration in blood was monitored routinely, and adjusted to a target through low level. In this case, there was no significant difference in the incidence of PTDM when compared between CsA and Tac groups; (3)The incidence of PTDM in elderly group was significantly higher than that in low-age group.CONCLUSIONHLA-A30 and HLA-DR7 are the susceptible genes of PTDM in Hunan and parts of Jiangxi province, if we find any recipient with each one of the two genes, we should pay special attention to him (or her), routinely monitor posttransplantational blood sugar and urine sugar, and adjust immunosuppressants when necessary; Tacrolimus doesn't significantly increase the incidence of PTDM under the principle of "Low dosage of Drugs and Monitored Low Concentration in Blood"; Elderly patients have a higher risk of developing PTDM, in addition, they have a higher incidence of underlying cardio-cerebrovascular disease, PTDM hence makes them more susceptible to cardio-cerebrovascular events, so it is more important for us to monitor posttransplantational blood sugar, urine sugar and control hyperglycemia of the elderly patients. Establishing individualized immunosuppressive regimen is also necessary.