Pediatrik renal transplant alıcılarında transplantasyon sonrası yeni gelişen diyabetes mellitus riskini arttıran faktörler
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Tarih
2019
Yazarlar
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Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Nakil sonrası yeni gelişen diyabetes mellitus (NODAT), böbrek naklinin önemli bir komplikasyondur. Bu çalışmanın amacı, tek bir merkezdeki böbrek nakli alıcıları arasında NODAT insidansını ve ilişkili faktörleri değerlendirmektir. Gereç ve Yöntem: Mayıs 1994 – Temmuz 2018 ayları arasında Ege Üniversitesi Tıp Fakültesi Çocuk Nefroloji Kliniğinde böbrek transplantasyonu yapılan 1-19 yaş aralığında 138 hasta retrospektif olarak değerlendirildi. Daha öncesinde diyabetes mellitus tanısı olmayan, en az 6 aylık izlem süresi olan hastalar çalışmaya dahil edildi. Literatürde bildirilen risk faktörleri araştırılarak demografik, antropometrik ve laboratuvar parametrelerine ilişkin veriler kaydedildi. Hastalar istatistiksel karşılaştırma için NODAT olan ve olmayan olarak iki gruba ayrıldı. Bulgular: Çalışma süresince böbrek nakli olan toplam 145 hastadan 138 böbrek nakil alıcısı analize dahil edildi. NODAT insidansı %9,4 (n=13) olarak saptandı. NODAT grubunda kız cinsiyeti %84, yaş ortalaması 13,9±2,5, kadavra vericiden nakil %84 idi. NODAT tanı alma ortanca süresi nakil sonrası 60 (10-750) gün olarak saptandı. Bu hastaların 9'u (%69) ilk 6 ay içerisinde tanı almıştı. NODAT gelişmeyen grupta (n=125) kız cinsiyeti %42,9, yaş ortalaması 11,2±4,3, kadavra vericiden nakil %46,4 idi. Kız cinsiyet ve kadavra vericili nakil açısından iki grup arasında istatistiksel olarak anlamlı fark bulundu (sırasıyla p=0,004, p=0,009). Erkek verici cinsiyeti, 13 yaş ve üzeri alıcı yaşı, periton diyaliz öyküsü NODAT grubunda daha fazla sıklıktaydı, ancak iki grup istatistiksel olarak anlamlı fark saptanmadı. Takrolimus alan hastalar (%14,1), siklosporin alan hastalardan (%3,3) daha yüksek NODAT insidansına sahipti. Alıcı cinsiyetine bakıldığında kız erkeğe göre 6,7 kat NODAT gelişimi açısından daha riskli saptandı (p=0,013). Verici tipine göre ise kadavra vericili nakil, canlı nakile göre 5,6 kat daha riskli bulundu (p=0,024). İlk yıl takrolimus kan düzeyi ortalamasına göre ilaç kan düzeyi arttıkça NODAT gelişim riski 1,34 kat arttığı (p=0,02), 2. yıl takrolimus kan düzeyi ortalamasına göre ilaç kan düzeyi arttıkça riskin 1,37 kat arttığı saptandı (p=0,02). Sonuç: Pediatrik böbrek nakli alıcılarımızda, özellikle nakil sonrası ilk 6 ay NODAT insidansı yüksekti. Kız cinsiyeti, kadavra vericili nakil ve yüksek takrolimus kan düzeyi risk faktörleriydi. İmmünsüpresif tedavi seçimi, anlamlılığa ulaşan tek değiştirilebilir risk faktörüydü. Yakın izlem ve modifiye edilmiş protokoller takrolimusun yan etkilerini en aza indirmeye yardımcı olabilir. Risk faktörlerinin daha net anlaşılması, nakil sonrası izlemede ve klinik karar vermede rehberlik edebilir.
Aim: New-onset diabetes mellitus after transplantation (NODAT) is a major complication of kidney transplant. The aim of this study was to evaluate the incidence and associated factors of NODAT among kidney transplant recipients in a single center. Material and Method: Between May 1994 and July 2018, 138 patients 1- 19 years of age who underwent renal transplantation in Ege University Medical Faculty Pediatric Nephrology Clinic were evaluated retrospectively. Patients who had no previous diagnosis of diabetes mellitus and had a follow-up of at least 6 months were included in the study. Risk factors reported in the literature were investigated and data on demographic, anthropometric and laboratory parameters were recorded. Patients were divided into two groups: With and without NODAT – for statistical comparison. Result: A total of 145 patients with renal transplantation during the study, of them 138 kidney transplant recipients were included in the analysis. The incidence of NODAT was 9.4% (n = 13). In the NODAT group, female gender was 84%, mean age was 13.9 ± 2.5 years, and the rate of transplantation from cadaver donor was 84%. The median time of NODAT diagnosis was 60 (10-750) days after transplantation. Nine (69%) of these patients were diagnosed within the first 6 months. In the non-NODAT group (n = 125), female gender was 42.9%, mean age was 11.2 ± 4.3 years and transplantation from cadaver donor was 46.4%. A statistically significant difference was found between the two groups in terms of female gender and cadaver donor transplantation (p = 0.004, p = 0.009, respectively). Male donor gender, age of 13 years and older, and history of peritoneal dialysis were higher frequent in the NODAT group, but there was no statistically significant difference between the two groups. Patients receiving cyclosporine (3.3%) had a lower incidence of NODAT than patients receiving tacrolimus (14.1%). When the gender of the recipient was examined, it was found to be 6.7 times greater risk for the development of NODAT than boys (p = 0.013). According to donor type, cadaver donor was found to be 5.6 times greater risk than living donor (p = 0.024). According to the average blood level of tacrolimus during the first year, as the blood level of the drug increased, the risk of developing NODAT increased by 1.34 times (p = 0.02), according to the mean tacrolimus blood level during the second year, the risk increased by 1.37 times as the drug blood level increased (p = 0.02). Conclusion: The incidence of NODAT was high in our pediatric kidney transplant recipients, especially in the first 6 months after transplantation. Female gender, cadaver donor transplantation and high tacrolimus blood level were risk factors. The choice of immunosuppressive therapy was the only modifiable risk factors reaching significance. Close monitoring and modified protocols can help minimize the side effects of tacrolimus. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.
Aim: New-onset diabetes mellitus after transplantation (NODAT) is a major complication of kidney transplant. The aim of this study was to evaluate the incidence and associated factors of NODAT among kidney transplant recipients in a single center. Material and Method: Between May 1994 and July 2018, 138 patients 1- 19 years of age who underwent renal transplantation in Ege University Medical Faculty Pediatric Nephrology Clinic were evaluated retrospectively. Patients who had no previous diagnosis of diabetes mellitus and had a follow-up of at least 6 months were included in the study. Risk factors reported in the literature were investigated and data on demographic, anthropometric and laboratory parameters were recorded. Patients were divided into two groups: With and without NODAT – for statistical comparison. Result: A total of 145 patients with renal transplantation during the study, of them 138 kidney transplant recipients were included in the analysis. The incidence of NODAT was 9.4% (n = 13). In the NODAT group, female gender was 84%, mean age was 13.9 ± 2.5 years, and the rate of transplantation from cadaver donor was 84%. The median time of NODAT diagnosis was 60 (10-750) days after transplantation. Nine (69%) of these patients were diagnosed within the first 6 months. In the non-NODAT group (n = 125), female gender was 42.9%, mean age was 11.2 ± 4.3 years and transplantation from cadaver donor was 46.4%. A statistically significant difference was found between the two groups in terms of female gender and cadaver donor transplantation (p = 0.004, p = 0.009, respectively). Male donor gender, age of 13 years and older, and history of peritoneal dialysis were higher frequent in the NODAT group, but there was no statistically significant difference between the two groups. Patients receiving cyclosporine (3.3%) had a lower incidence of NODAT than patients receiving tacrolimus (14.1%). When the gender of the recipient was examined, it was found to be 6.7 times greater risk for the development of NODAT than boys (p = 0.013). According to donor type, cadaver donor was found to be 5.6 times greater risk than living donor (p = 0.024). According to the average blood level of tacrolimus during the first year, as the blood level of the drug increased, the risk of developing NODAT increased by 1.34 times (p = 0.02), according to the mean tacrolimus blood level during the second year, the risk increased by 1.37 times as the drug blood level increased (p = 0.02). Conclusion: The incidence of NODAT was high in our pediatric kidney transplant recipients, especially in the first 6 months after transplantation. Female gender, cadaver donor transplantation and high tacrolimus blood level were risk factors. The choice of immunosuppressive therapy was the only modifiable risk factors reaching significance. Close monitoring and modified protocols can help minimize the side effects of tacrolimus. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.
Açıklama
Anahtar Kelimeler
Böbrek Nakli, Diyabetes Mellitus, İnsidans, Risk Faktörleri, Renal Transplantation, Diabetes Mellitus, İncidence, Risk Factors
