Ümit Çakmak, Özgür Merhametsiz, Süleyman Akkaya, Nurettin Ay
Anatolian Current Medical Journal - 2025;7(6):933-939
Aims: Kidney transplantation is one of the preferred treatment modalities in end-stage renal disease (ESRD) and significantly preserves kidney function and the patient's quality of life. However, post-transplant diabetes mellitus (PTDM) is a common complication, occurring in approximately one-third of renal transplant recipients. The main aims of our study were to determine the risk factors associated with the development of PTDM in renal transplant patients, to demonstrate its incidence, and to evaluate its long-term consequences on graft and patient survival. Methods: This single-center retrospective study included 242 non-diabetic kidney transplant recipients who underwent transplantation between January 2014 and December 2022. Patients with pre-existing diabetes, younger than 18 years old, multiple transplants or graft survival of less than one year were excluded. Demographic data, immunosuppressive regimens, perioperative glucose levels and laboratory findings were collected. All patients classified as having PTDM required glucose-lowering treatment-either oral antidiabetic agents or insulin-initiated after the third month post-transplant, confirming the persistence of hyperglycemia beyond the early postoperative period. Statistical analysis were performed using IBM SPSS 22 with categorical variables compared using Pearson Chi-square test and continuous variables using Mann-Whitney U test. ROC analysis logistic regression were conducted to identify risk factors for PTDM. Results: PTDM developed more frequently in older (45 vs. 33 years, p<0.001) and higher body-mass index (BMI) recipients (26 vs. 21.7 kg/m², p<0.001). Pretransplant hypertension and coronary artery disease (CAD) were significantly more common in the PTDM group (48.6% vs. 29.3%, p=0.020; 13.5% vs. 2%, p=0.003). ROC analysis identified cutoff values of 36.5 years for age (AUC 0.701) and 24.5 kg/m² for BMI (AUC 0.732) in predicting PTDM. In multivariate logistic regression, independent predictors of PTDM were recipient age, BMI, pretransplant CAD, perioperative glucose level, and duration of renal replacement therapy. Among them, BMI and pretransplant CAD showed the strongest associations (OR 1.205, p<0.001; OR 7.373, p=0.015). Conclusion: The study found a 15.2% incidence of PTDM. Older age, higher BMI, pre-transplant CAD, and elevated perioperative glucose levels were identified as key risk factors. Notably, no significant differences in graft survival or mortality were observed between PTDM and non-PTDM groups, despite PTDM's known adverse effects.
