New onset diabetes after kidney transplantation in Asian Americans – Is there an increased risk?

Summary

New-onset diabetes after transplantation (NODAT) is increasing in frequency and creates many challenges directly impacting the patient and graft survival. Most transplant programs offer a fixed-dose prednisone taper schedule for the prevention of acute rejection following kidney transplantation. In this study, we investigated the incidence of NODAT in new kidney transplant recipients.

Methods

This was a retrospective, single-center study assessing rates of NODAT according to age, ethnicity, body weight, BMI, rejection, and prednisone dosing among kidney transplant recipients.

Results

Among non-diabetic consecutive kidney transplant recipients (n = 261) from 1/2014 to 12/2018, a total of 47 (18%) kidney transplant recipients developed NODAT. After adjusting for common NODAT risk factors, analysis of the population indicated that age, and corticosteroid dose in the Asian American population [adjusted for lower body weight, BMI] significantly increased the risk of NODAT. In multi-variance analysis, despite receiving lower standard doses of protocol corticosteroid daily, when adjusted for actual body weight (mg/kg/day) Asian American recipients had high incidence of NODAT compared to other ethnicity. Asian American received higher doses or corticosteroids (prednisone) than non-Asian Americans (0.14 mg/kg vs. 0.11 mg/kg) (p = 0.008). The overall incidence of rejection was not higher among those who developed NODAT (p = 0.55)

Conclusion

This is the first study to explore the relationship between corticosteroid dose and diabetes in Asian Americans. Asian Americans had higher rates of NODAT and received higher doses of weight-based corticosteroids. There is a possible iatrogenic, pharmacogenomic, and addressable etiology to NODAT in this population.