Korean Journal of Nephrology 1998;17(6):957-962.

산이식후 당뇨병의 위험인자와 임상적 고찰 (Risk Factors and Clinical Characteristics of Post-Renal Transplant Diabetes Mellitus)

장미화, 정선동, 이용환, 이지현, 김근태, 공지민 (Mi Hwa Jang, Sun Dong Jung, Yong Hwan Lee, Ji Hyun Lee, Keun Tae Kim and Jin Min Kong)

Abstract

To investigate the risk factors and clinical characteristics of post-renal transplant diabetes mellitus (PTDM), we reviewed the records of 177 renal allograft recipients in Maryknoll Hospiatal whose allografts had functioned longer than 6 months. Nineteen patients(10.7%) developed PTDM at 5.0±7.8(1-52)months; 9(47%) of these within 1 month. PTDM patients were older than non-diabetic renal transplants(42±2 vs 37±1 years, P<0.05). Body mass index tended to be higher in PTDM(23.5±1.0 vs 21.8±0.3kg/m2, P=0.09). Number of acute rejections (0.6±0.2 vs 0.5±0.1) and serum creatinine at 1 year after transplantation(1.2±0.8 vs 1.3±0.3mg/dL) were not different. Fasting(103.6±10.4 vs 84.4±1.6mg/dL, P<0.05) and postprandial(189.2±24.8 vs 118.6±2.3 mg/dL, P<0.01) blood sugars, measured before transplantation, were higher in PTDM. CsA blood level at 1 month posttransplantation was higher in PTDM (350±34 vs 279±8ng/mL, P<0.05). Fasting serum insulin was significantly higher(28.2±12.2 vs 7.3±2.0 μU/dL, P<0.05) and serum C-peptide tended to be higher in PTDM patients compared with euglycemic renal recipients(6.3±1.6 vs 3.8±0.9ng/dL, P=0.08). All the PTDM patients were treated by either insulin or oral agent; 15 of 19 required no treatment after 4.7±6.9 months. In conclusion, prevalence of PTDM was 10.7%. PTDM patients were older. Body mass index was tended to be higher. Fasting and postprandial blood sugars, measured before transplantation, were higher in PTDM. Faslting serum insulin was higher and C-peptide tended to be higher in diabetics. These results suggested that increased insulin resistance plays a major role in the pathogenesis of PTDM.