The Impact Mechanism Of Liver And Renal Dysfuction With Diabetes Mellitus After Renal Transplantation

Objective By observing the changes of liver and renal function before and after renal transplantation in renal transplant patients,the risk factors related to the incidence of post-transplantation diabetes mellitus(PTDM)were explored,the influencing factors for the long-term survival of patients were evaluated and new clinical evidence for prevention and treatment of PTDM was provided.Methods The clinical data of patients undergoing allogeneic renal transplantation in the Tertiary Hospital,from January 2010 to October 2016 were selected.After exclusion from the criteria,the remaining 237 patients were followed up for analysis.The study was followed up until December 2017.1.The patients were divided into PTDM and N-PTDM group according to the FPG value after 4 weeks of transplantation.The single-factor analysis was performed on the risk factors of PTDM.The risk factors were analyzed by multi-factor analysis to analyze the independent risk factors of PTDM.2.Analyze the changes of liver enzymes(ALT),blood lipids(TC,TG,HDL-C,LDL-C)and fasting plasma glucose(FPG)before and after surgery,and analyze their relationship with the occurrence and development of PTDM.3.According to the changes of postoperative FPG,the incidence of PTDM at different times was analyzed.According to the duration of PTDM,PTDM was divided into transient PTDM and persistent PTDM,and the PTDM outcome factors were analyzed.4.The difference of serum creatinine and urea levels between preoperative and postoperative were compared at different time points.The survival curves of PTDM group and N-PTDM group were drew and the factors affecting the survival of renal transplant patients were analyzed.Results 1.Trends analysis of ALT,blood lipids and FPG after renal transplantation Within one month after the operation,the patient's FPG showed a trend of increasing first and then decreasing in N-PTDM and PTDM,and it was the most obvious within 1 week after the operation.Similar to FPG,within 1 month after the operation,the ALT levels in the PTDM group and the N-PTDM group increased first and then decreased.Between the two groups,the ALT levels in the PTDM group were significantly higher than the N-PTDM group between 3 and 4 weeks after surgery,and the difference was statistically significant(P<0.05).Within 2 weeks after the operation,the levels of HDL-C and LDL-C in both groups decreased compared with preoperatively,and TC levels at 3-4 weeks after operation were significantly higher than those in N-PTDM group(P<0.05).2.Risk factors for PTDM By multi-factor analysis,age(OR=1.052,P=0.01),FPG(OR=2.169,P=0.000)at 4 weeks after the operation,and ALT level(OR=0.964,P=0.003)at 4 weeks after the operation were important risk factors in the pathogenesis of PTDM.3.Analysis of renal function after PTDM Creatinine and urea in the postoperative PTDM group decreased significantly,but remained at a high level within 1 month after the operation.It decreased further after 1 month and gradually returned to the normal range 2 years after surgery.At 4 weeks after operation,creatinine and urea levels in the PTDM group were higher than those in the N-PTDM group,and the difference was statistically significant(P<0.05).4.Prevalence and outcome of PTDM In 237 patients with preoperative non-diabetic conditions,the number of new cases in the first postoperative year was the highest,and increased with an average of 2-3 cases/month.Of the 97 patients diagnosed with PTDM,57 were early-onset PTDM and 40 were late-onset PTDM.At the end of follow-up,64 patients persisted,and 33 patients had normalized FPG.Conclutions 1.The prevalence of PTDM was 17.67% within the first year after renal transplantation in Tertiary Hospital.44.07% of new cases occurred within 6 months after the operation;65.98% were persistent PTDM,34.02% FPG turns to normal.2.Preoperative LDL-C levels and FPG,ALT,TC,and LDL-C levels at 4 weeks after the operation were suggested to be risk factors for the development of PTDM for early detection of PTDM.Age,BMI and systolic pressure are risk factors for PTDM.3.The recovery of renal function in the PTDM group after transplantation was slower than that of the N-PTDM group.This phenomenon increased the incidence of PTDM.PTDM has no significant effect on patients' renal function and survival.