Diabetes mellitus após transplante renal e fatores associados ao seu desenvolvimento em um serviço de referência do estado do Ceará

Abstract

Post-transplant diabetes mellitus (PTDM) remains as an important complication after organ transplantation (Tx) and its occurrence is associated with increased morbidity and mortality. Its incidence is widely variable ranging from 2.5% to 45%. Despite that, renal transplantation is accepted as the most effective choice of therapy and the one that offers the best quality of life for patients with terminal chronic renal disease. The aim of this study is to characterize the incidence of PTDM and the factors associated with its development in renal transplant recipient population in a reference center in the state of Ceara, Brazil. This is a historical cohort study based on the assessment of medical records, which included patients undergoing renal transplantation in the period from January 2006 to December 2010, in a tertiary care public hospital in the State of Ceara, Brazil. During this period 430 kidney transplants were performed with 92 patients being excluded from study. Exclusion criteria included patients younger than 18 years old, those who underwent transplantation of another organ, those with less than three months post-transplantation follow-up and with insufficient data. Diabetes mellitus was a pre-Tx condition in 9.1% of patients. Hyperglycemia during the first post-Tx month was seen in 34,5% of the patients. The occurrence of DMPT found at the end of study was 19.9%, and the main factors associated with its development were: fasting blood glucose one month after Tx (p <0.001; OR = 1.05), the occurrence of acute rejection (p=0.003; OR = 6.43), pre-Tx impaired fasting blood glucose (p = 0.014; OR = 4.10) and a deceased donor Tx (p = 0.015; OR = 3.53). The main risk factors associated with its development were: acute rejection episodes, recipients from a deceased donor, impaired fasting glucose in the pre-Tx period and fasting blood glucose after the first 30 days post-Tx. Considering that the development of PTDM is associated with a higher risk of complications, the relevance of identifying the risk factors associated with its development would facilitate decision making regarding the optimization of preventive strategies during patient evaluation, before and after transplantation.