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Kidney Week

Abstract: PO2521

Post-Transplant Diabetes Mellitus in a Single Pediatric Kidney Transplant Center: Risk Factors, Outcomes, and Characterization of Clinical Course

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Khanna, Anjali, Emory University School of Public Health, Atlanta, Georgia, United States
  • Ham, Jee-Young Nina, Emory University School of Medicine, Atlanta, Georgia, United States
  • Kamel, Margret, Emory University School of Medicine, Atlanta, Georgia, United States
  • Ngo, Kathryn My Tuyet, Emory University School of Public Health, Atlanta, Georgia, United States
  • Thomas, Amanda S., Emory University School of Medicine, Atlanta, Georgia, United States
  • Liverman, Rochelle, Children's Healthcare of Atlanta Egleston Hospital, Atlanta, Georgia, United States
  • Garro, Rouba, Emory University School of Medicine, Atlanta, Georgia, United States
Background

The prevalence and outcomes of post-transplant diabetes mellitus (PTDM) in pediatric kidney transplant (KT) recipients vary among studies due to the lack of a consistent definition. Risk factors for and pathogenesis of pediatric PTDM are incompletely understood.

Methods

PTDM prevalence, risk factors and disease course was evaluated at a high volume, tertiary care pediatric hospital. We performed a retrospective review of pediatric KT recipients between 2006-2016 to evaluate PTDM prevalence. PTDM was defined as persistent hyperglycemia with serum glucose ≥200 mg/dl, HbA1C ≥6.5%, and requiring antihyperglycemic treatment for ≥ 30 days. Full data were available on all patients transplanted between 2010-2016 and were used to compare demographic and clinical characteristics between PTDM (n=9) and non-PTDM patients (n=173) using Chi-square and Wilcoxon rank sum tests.

Results

Between 2006-2016, 312 patients received KT. Five patients with pre-existing DM were excluded. Fifteen developed PTDM with a prevalence estimate of 4.89 % (95% CI: 3% - 8%) and median time from transplant to DM was 17.6 months (25th-75th: 3 – 83). The majority of PTDM patients had a family history of DM in 1st degree relatives (81%) and were maintained on tacrolimus at diagnosis (67%).PTDM diagnosis and insulin initiation occurred in the context of active rejection episode in only two patients. Despite a more stringent definition of PTDM, insulin therapy was discontinued in 3/15 (20%) patients who continued to be normoglycemic. Comparing patients with and without PTDM during the period 2010-2016 revealed that PTDM patients had higher BMI-Z scores at transplant (p=0.053) and higher average blood glucose during the first week post KT (p=0.095), with no difference in age, gender, race, donor status, or dialysis modality.

Conclusion

A more consistent definition of PTDM and larger studies are warranted to better understand the prevalence, risk factors, and pathogenesis of hyperglycemia and PTDM in children. Detailed patient-level data can provide nuance that may be missed with larger registry studies.

Funding

  • Private Foundation Support