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Abstract: TH-PO996

POWERED Study: Prophylaxis With Metformin to Prevent Post-Transplant Diabetes Mellitus

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Allan, Michelle Elizabeth, Barts Health NHS Trust, London, London, United Kingdom
  • Chowdhury, Tahseen Ahmad, Barts Health NHS Trust, London, London, United Kingdom
  • Fan, Stanley, Barts Health NHS Trust, London, London, United Kingdom
  • Yaqoob, Muhammad Magdi, Barts Health NHS Trust, London, London, United Kingdom
  • Mccafferty, Kieran, Barts Health NHS Trust, London, London, United Kingdom
Background

Advances in immunosuppression have improved kidney transplant outcomes. However, calcineurin inhibitors and steroids, and other transplant-specific and general diabetogenic risk factors, contribute to the development of post-transplant diabetes mellitus (PTDM). PTDM is associated with increased cardiovascular morbidity and mortality, graft loss and infection. Despite its clinical relevance, there has been a historic lack of diagnostic criteria or clear management strategies. Rather than treating patients who have already developed PTDM, new trials are focusing on prevention.

Methods

We present the results of a single-centre prospective randomised placebo-controlled trial comparing metformin 500mg OD vs placebo in kidney transplant recipients in the first 3 months post-transplant. 60 patients who passed screening within 10 days of transplant, including eGFR >/=30ml/min and 2hr oral glucose tolerance test (OGTT) <11.1 mmol/L, were randomised to either metformin (n=30) or placebo (n=30). They returned at 3, 6 and 12 months post-transplant for fasting bloods, including OGTT.

The primary endpoint was a diagnosis of PTDM, defined by a positive OGTT. Secondary endpoints included the effect on HbA1c, HOMA-IR, impaired glucose tolerance or elevated fasting plasma glucose, renal function, graft/patient survival and safety.

Results

The groups were well-matched for baseline demographics including age, ethnicity, BMI, cause of ESRF, co-morbidities, immunological risk and induction. There was no significant difference in PTDM development survival curves by either OGTT or composite outcome (OGTT, IGT, FPG, HbA1c, Rx) log-rank p0.53 and p0.41, respectively. There was no difference in renal function, HOMA-IR or in safety signal.

Conclusion

Metformin was not associated with a reduction in the diagnosis of PTDM at this dose and in this study which was significantly impacted by the COVID-19 pandemic, especially with regards to missing data during follow-up. However, there is no contraindication to further studies including larger doses of metformin or patients with positive OGTT at baseline.

Figure 1: time to PTDM diagnosis

Funding

  • Clinical Revenue Support