Association Between Use of FK506 and Prevalence of Posttransplantation Diabetes Mellitus in Kidney Transplant Patients L.C. Weng, Y.J. Chiang, M.H. Lin, C.Y. Hsieh, S.C. Lin, T.Y. Wei, and H.F. Chou ABSTRACT Background. Tacrolimus (FK506) use has been suggested as a risk factor for posttransplantation diabetes mellitus (PTDM) because it can impair insulin secretion. This association warrants further investigation. This study aimed to examine the prevalence of PTDM and its association with FK506 use in kidney transplant recipients. The study also aimed to examine the relationship of FK506 use and diabetes-related biologic markers. Methods. A retrospective chart review was used to collect data at a medical center in northern Taiwan from September 2003 to February 2012. PTDM was defined with the use of the criteria of the American Diabetes Association. Results. Among 166 patients included in the analysis, PTDM was reported in 49 patients (29.5%). A total of 93 patients used the FK506 regimen, of whom 34 (36.6%) were PTDM cases. Logistic regression showed that FK506 use (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.20e6.11; P ¼ .016) and older age (OR,1.08; 95% CI, 1.03e1.13; P ¼ .001) were significant risk factors for PTDM. In addition, FK506 use in PTDM cases was associated with a significantly higher hemoglobin A1c level (7.55 vs 5.81; P ¼ .01) and a borderline significantly higher insulin resistance index (3.24 vs 1.92; P ¼ .053) than was FK506 use without the presence of PTDM. Conclusions. Older age and an FK506 regimen were important predictors of the prevalence of PTDM. Greater early detection and prevention efforts for PTDM are needed for older transplant recipients. PTDM patients with an FK506 regimen had higher hemoglobin A1c levels and insulin resistance index than did patients who did not use FK506. The association of serum indicators with FK506 use in the prevalence of PTDM warrants further investigation.
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OST-TRANSPLANTATION diabetes mellitus (PTDM) is a known complication of transplantation [1]. It has been reported to be associated with cardiovascular disease, graft failure, and length of patient survival [2e6] as well as with an increase in the medical expenditures of kidney transplantation [7]. PTDM may also affect the long-term outcomes of transplantation patients. Early detection of PTDM risk factors and PTDM management are concerns of post-transplantation care. Several risk factors for PTDM have been reported, including age, body mass index, hepatitis C infection [1,8e11], and immunosuppressive medication [1,12]. Tarcolimus (FK506) had been reported as a risk factor for PTDM because it can cause insulin hyposecretion ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 529e531 (2014)
[1,6,13]. However, the relationship of FK506 use with other diabetes-related biologic markers has not been investigated. Therefore, the purpose of the present study was to examine the association of FK506 use with the prevalence of PTDM and diabetes-related biologic markers in kidney transplantation recipients. From the School of Nursing, College of Medicine, Chang Gung University (L.C.W., H.F.C.); and Transplantation Center and Urology Surgery (Y.J.C.) and Department of Nursing (M.H.L., C.Y.H., S.C.L., T.Y.W.), Chang Gung Medical FoundationeLinkuo Medical Center, Taoyuan, Taiwan. Address reprint requests to Yang Jen Chiang, 5, Fushing Street, Kwei-Shan, Taoyuan, Taiwan. E-mail: [email protected] 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.11.141 529
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METHODS Design and Sample A retrospective chart review was used to collect the data of patients who had received kidney transplantation from September 2003 to February 2012 at a medical center in northern Taiwan. Patients’ data were excluded if the patient was 200 mg/dL on >1 occasion, or patients who had DM symptoms 3 months after undergoing kidney transplantation that were managed with an oral antidiabetic drug or insulin injection therapy. The Institutional Review Board of the study site approved the study (approval no 99e1717B).
Statistics Statistical analysis was performed with the use of PASW, version 17.0 (formerly called SPSS), software. Descriptive statistics such as means, standard deviations, frequencies, and percentages were provided for the study variables. Binary statistical analyses such as chi-square tests and independent-sample t tests were used to evaluate the associations of study variables with PTDM. A multivariate logistic regression analysis was used to evaluate the effect of the risk factors on PTDM.
RESULTS
A total of 183 patients received kidney transplantation in our center from 2003 to 2012. Of these patients, data from 17 were excluded (5 patients were
P
OST-TRANSPLANTATION diabetes mellitus (PTDM) is a known complication of transplantation [1]. It has been reported to be associated with cardiovascular disease, graft failure, and length of patient survival [2e6] as well as with an increase in the medical expenditures of kidney transplantation [7]. PTDM may also affect the long-term outcomes of transplantation patients. Early detection of PTDM risk factors and PTDM management are concerns of post-transplantation care. Several risk factors for PTDM have been reported, including age, body mass index, hepatitis C infection [1,8e11], and immunosuppressive medication [1,12]. Tarcolimus (FK506) had been reported as a risk factor for PTDM because it can cause insulin hyposecretion ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 Transplantation Proceedings, 46, 529e531 (2014)
[1,6,13]. However, the relationship of FK506 use with other diabetes-related biologic markers has not been investigated. Therefore, the purpose of the present study was to examine the association of FK506 use with the prevalence of PTDM and diabetes-related biologic markers in kidney transplantation recipients. From the School of Nursing, College of Medicine, Chang Gung University (L.C.W., H.F.C.); and Transplantation Center and Urology Surgery (Y.J.C.) and Department of Nursing (M.H.L., C.Y.H., S.C.L., T.Y.W.), Chang Gung Medical FoundationeLinkuo Medical Center, Taoyuan, Taiwan. Address reprint requests to Yang Jen Chiang, 5, Fushing Street, Kwei-Shan, Taoyuan, Taiwan. E-mail: [email protected] 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2013.11.141 529
530
METHODS Design and Sample A retrospective chart review was used to collect the data of patients who had received kidney transplantation from September 2003 to February 2012 at a medical center in northern Taiwan. Patients’ data were excluded if the patient was 200 mg/dL on >1 occasion, or patients who had DM symptoms 3 months after undergoing kidney transplantation that were managed with an oral antidiabetic drug or insulin injection therapy. The Institutional Review Board of the study site approved the study (approval no 99e1717B).
Statistics Statistical analysis was performed with the use of PASW, version 17.0 (formerly called SPSS), software. Descriptive statistics such as means, standard deviations, frequencies, and percentages were provided for the study variables. Binary statistical analyses such as chi-square tests and independent-sample t tests were used to evaluate the associations of study variables with PTDM. A multivariate logistic regression analysis was used to evaluate the effect of the risk factors on PTDM.
RESULTS
A total of 183 patients received kidney transplantation in our center from 2003 to 2012. Of these patients, data from 17 were excluded (5 patients were
