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Posttransplantation diabetes mellitus

Abbey Barnard, Peter Konyn, Sammy Saab
Improved short- and long-term survival of liver transplant recipients has led to increased focus on complications of both the early and late posttransplant periods. A variety of metabolic complications have been observed in the post-orthotopic liver transplant population, including hypertension, hyperlipidemia, obesity, diabetes mellitus, nonalcoholic fatty liver disease, and nonalcoholic steatohepatitis. Although only a small proportion of patients experience metabolic complications prior to transplantation, the prevalence of these complications posttransplantation reaches or exceeds that of the general population...
October 2016: Gastroenterology & Hepatology
Thomas Schachtner, Maik Stein, Petra Reinke
Previous studies on patient and allograft outcomes of obese kidney transplant recipients (KTRs) remain controversial. To what extent obesity-related comorbidities contribute to adverse outcomes, however, hasn't been addressed. We studied all KTRs from 2005 to 2012. 29 (4%), 317 (48%), 217 (33%), 76 (12%), and 21 KTRs (4%) were identified as underweight, normal-weight, overweight, obese, and morbid obese, respectively. 33 of 97 obese KTRs (34%) had pre-existent diabetes. Samples were collected before transplantation and at +1, +2, +3months posttransplantation...
November 27, 2016: Transplant Immunology
David Langsford, Varuni Obeyesekere, Sara Vogrin, Jessie Teng, Richard J MacIsaac, Glenn Ward, Frank Alford, Karen M Dwyer
BACKGROUND: Dysglycemia (encompassing impaired glucose tolerance and diabetes mellitus) arising after renal transplantation is common and confers a significant cardiovascular mortality risk. Nonetheless, the pathophysiology of posttransplant dysglycemia is not well described. The aim of this study was to prospectively and comprehensively assess glucose handling in renal transplant recipients from before to 12 months after transplantation to determine the underpinning pathophysiology. MATERIALS AND METHODS: Intravenous and oral glucose tolerance testing was conducted before and at 3 and 12 months posttransplantation...
November 2016: Transplantation Direct
A M Glazunova, M S Arutyunova, E V Tarasov, L V Nikankina, A V Il'in, M Sh Shamkhalova, M V Shestakova, Ya G Moisyuk
AIM: To study the markers of renal graft dysfunction in patients with type 1 diabetes mellitus (T1DM) after kidney transplantation (KT) and simultaneous pancreas-kidney transplantation (SPKT). SUBJECTS AND METHODS: The investigation enrolled 20 patients after successful SPKT and 41 patients after KT (of them 21 received continuous subcutaneous insulin infusion with an insulin doser; 20 had multiple insulin injections). The periods after KT and SPKT at patient inclusion were 8 (7; 8) and 11 (8; 18) months, respectively...
2016: Terapevticheskiĭ Arkhiv
Isabell Jahn, Martin Busch, Undine Ott, Gunter Wolf, Wilgard Battefeld
BACKGROUND: Transplantation (NTX) associated ischemia-reperfusion-mechanisms and the predisposition for insulin resistance are discussed as causes of a posttransplantation diabetes mellitus (PTDM). Furthermore, immunosuppressants can have a damaging effect on insulin secretion. METHODS: 55 metabolically healthy patients with an endstage renal disease (age 52 ± 14 years, body mass index 27 ± 5 kg / m(2), blood pressure 137 ± 15/82 ± 11 mmHg) were included in a prospectively cohort study...
September 2016: Deutsche Medizinische Wochenschrift
Georges Mourad, Maciej Glyda, Laetitia Albano, Ondrej Viklický, Pierre Merville, Gunnar Tydén, Michel Mourad, Aleksander Lõhmus, Oliver Witzke, Maarten Hl Christiaans, Malcolm Brown, Nasrullah Undre, Gbenga Kazeem, Dirk Rj Kuypers
No abstract text is available yet for this article.
August 19, 2016: Transplantation
Jin Sug Kim, Seul Ki Kim, Ji Yoon Park, Yang Gyun Kim, Joo Young Moon, Sang Ho Lee, Chun Gyoo Ihm, Tae Won Lee, Su Kang Kim, Joo-Ho Chung, Sun Woo Kang, Tae Hee Kim, Yeong Hoon Kim, Kyung Hwan Jeong
BACKGROUND: Posttransplantation diabetes mellitus (PTDM) is an important metabolic complication after renal transplantation. Activation of the innate immune system via toll-like receptors (TLRs) is implicated in the pathogenesis of insulin resistance and deficiency. Although links between diabetes, dysregulated innate immune responses, and the TLR signaling pathway have been reported, no study so far has investigated their associations with PTDM. In this study, we ascertained whether single nucleotide polymorphisms (SNPs) in TLRs are associated with PTDM in the Korea population...
2016: Nephron
Ivar Anders Eide, Thea Anine Strøm Halden, Anders Hartmann, Dag Olav Dahle, Anders Åsberg, Trond Jenssen
BACKGROUND: Previous reports indicate that posttransplantation diabetes mellitus (PTDM) is associated with overall renal graft loss, but not death-censored graft loss. METHODS: In this single-center retrospective cohort study of 2749 adult Norwegian renal transplant recipients, transplanted between 1999 and 2011, we estimated overall and death-censored renal graft loss hazard ratios in patients diagnosed with PTDM, impaired glucose tolerance and diabetes before transplantation, using multivariable Cox proportional hazard regression analysis...
June 29, 2016: Transplantation
Ivar Anders Eide, Thea Anine Strøm Halden, Anders Hartmann, Anders Åsberg, Dag Olav Dahle, Anna Varberg Reisaeter, Trond Jenssen
Current diagnostic criteria for post-transplantation diabetes mellitus (PTDM) are either fasting plasma glucose ≥7.0 mmol/l (≥126 mg/dl) or postchallenge plasma glucose ≥11.1 mmol/l (≥200 mg/dl) 2 h after glucose administration [oral glucose tolerance test (OGTT) criterion]. In this retrospective cohort study of 1632 renal transplant recipients (RTRs) without known diabetes mellitus at the time of transplantation, we estimated mortality hazard ratios for patients diagnosed with PTDM by either conventional glucose criteria or the proposed glycated haemoglobin (HbA1c) criterion [HbA1c ≥6...
May 2016: Transplant International: Official Journal of the European Society for Organ Transplantation
Kristin E Linder, William L Baker, Caroline Rochon, Scott T May, Patricia A Sheiner, Spencer T Martin
BACKGROUND: Impaired glucose regulation posttransplantation can affect allograft survival and may lead to the development of posttransplant diabetes mellitus (PTDM). OBJECTIVES: The primary purpose of this study is to assess the difference in insulin burden between liver transplant patients who develop PTDM and patients who do not. METHODS: This was a single-center, retrospective study. Adult liver transplant recipients transplanted between January 1, 2005, and August 1, 2013, were included...
May 2016: Annals of Pharmacotherapy
Stanislas Faguer, Laure Esposito, Audrey Casemayou, Yves Pirson, Stéphane Decramer, Claire Cartery, Marc Hazzan, Valérie Garrigue, Gwenaelle Roussey, Olivier Cointault, Thien Ho, Pierre Merville, Olivier Devuyst, Pierre Gourdy, Nicolas Chassaing, Jean-Loup Bascands, Nassim Kamar, Joost-Peter Schanstra, Lionel Rostaing, Dominique Chauveau
BACKGROUND: Patients with HNF1B mutations develop progressive chronic renal failure, diabetes mellitus (40-50%), and liver tests abnormalities (40-70%). In HNF1B patients who reach end-stage renal disease, single kidney transplantation (SKT) or combined kidney-pancreas transplantation can be considered. METHODS: A retrospective multicenter study including 18 HNF1B patients receiving SKT or kidney-pancreas transplantation, and in vitro experiments including the characterization of the HNF1B expression after calcineurin inhibitor (CNI) exposure...
September 2016: Transplantation
Xianyang Zhang, Tengjiao Cui, Jinlin He, Haibo Wang, Renzhi Cai, Petra Popovics, Irving Vidaurre, Wei Sha, Janine Schmid, Barbara Ludwig, Norman L Block, Stefan R Bornstein, Andrew V Schally
Agonists of growth hormone-releasing hormone (GHRH) have been previously reported to promote growth, function, and engraftment of islet cells following transplantation. Here we evaluated recently synthesized GHRH agonists on the proliferation and biological functions of rat pancreatic β-cell line (INS-1) and islets. In vitro treatment of INS-1 cells with GHRH agonists increased cell proliferation, the expression of cellular insulin, insulin-like growth factor-1 (IGF1), and GHRH receptor, and also stimulated insulin secretion in response to glucose challenge...
November 3, 2015: Proceedings of the National Academy of Sciences of the United States of America
Ana Laura Pimentel, Andrea Carla Bauer, Joíza Lins Camargo
We conducted a literature review about renal posttransplantation diabetes mellitus (PTDM), a glucose metabolism alteration with high incidence. Immunosuppressive therapy, by different diabetogenic mechanisms, is the major risk factor for PTDM. Although corticosteroids and calcineurin inhibitors are the drugs most related to PTDM, the mechanisms of other drugs have been also investigated. Available data in the literature show that, in renal transplant patients, the oral glucose tolerance test presents the highest diagnostic sensitivity for PTDM, although fasting plasma glucose is the most requested test...
October 23, 2015: Clinica Chimica Acta; International Journal of Clinical Chemistry
Johannes Werzowa, Giovanni Pacini, Manfred Hecking, Catharina Fidler, Michael Haidinger, Helmut Brath, Andreas Thomas, Marcus D Säemann, Andrea Tura
AIM: Posttransplantation diabetes mellitus (PTDM) is a common complication after renal transplantation leading to increased cardiovascular morbidity and mortality. In subjects with type 2 diabetes (T2DM) increased glycemic variability and poor glycemic control have been associated with cardiovascular complications. We therefore aimed at determining glycemic variability and glycemic control in subjects with PTDM in comparison to T2DM subjects. METHODS: In this observational study we analyzed 10 transplanted subjects without diabetes (Control), 10 transplanted subjects with PTDM, and 8 non-transplanted T2DM subjects using Continuous Glucose Monitoring (CGM)...
November 2015: Journal of Diabetes and its Complications
E Çankaya, Y Bilen, M Keles, A Uyanik, N Bilen, B Aydınlı
AIM: Cardiovascular diseases and infections are the leading two causes of morbidity and mortality in end-stage renal disease (ESRD) patients. Kidney transplantation is the preferred method for renal replacement owing to better survival. There are reports of irreversibly damaged immune system in dialysis patients, which did not return to normal even after kidney transplantation. The neutrophil-lymphocyte ratio (NLR) is an easily applicable method for evaluation of inflammation. We hypothesized that preemptive kidney transplantation can improve inflammatory state compared with nonpreemptive recipients...
June 2015: Transplantation Proceedings
A M Nagib, M H Abbas, M M Abu-Elmagd, A A E F Denewar, A H Neamatalla, A F Refaie, M A Bakr
OBJECTIVES: Steroids have played a major role in renal transplantation for more than 4 decades. However, chronic use of steroids is associated with many comorbidities. This study aimed to assess the costs and benefits of a steroid-free immunosuppression regimen in a prospective randomized controlled study of living-donor renal transplantation, which was lacking in the literature. MATERIALS AND METHODS: In our study, 428 patients were enrolled to receive tacrolimus (Tac), mycophenolic acid (MPA), basiliximab (Simulect, Novartis, Basel, Switzerland) induction and steroids only for 3 days (214 patients, study group) and steroid maintenance (214 patients, control group)...
May 2015: Transplantation Proceedings
María José Pérez-Sáez, Mónica Marín-Casino, Julio Pascual
INTRODUCTION: Transplant physicians have tried to avoid graft rejection and early graft loss for many years. However, physicians are now aware about improving long-term kidney and patient survival, a challenge that needs to focus on cardiovascular risk management. One major contributor of this risk is the development of posttransplant diabetes mellitus (PTDM). AREAS COVERED: We performed a literature search based on PubMed, covering prevalence, risk factors, prevention and treatment of PTDM...
2015: Expert Opinion on Pharmacotherapy
Ana Laura Pimentel, Larissa Sant Anna Kellermann Carvalho, Samara Silva Marques, Rodrigo Fontanive Franco, Sandra Pinho Silveiro, Roberto Ceratti Manfro, Joíza Lins Camargo
BACKGROUND: The role of glycated hemoglobin (A1C) in the screening and diagnosis of posttransplantation diabetes mellitus (PTDM) is still not entirely understood. We evaluated the use of A1C test in renal transplant recipients at four months after transplantation. METHODS: A total of 122 out of 274 patients without previous diabetes that underwent kidney transplantation were enrolled. ROC curve was used to analyze the performance of A1C to diagnose PTDM considering OGTT as the reference standard...
May 20, 2015: Clinica Chimica Acta; International Journal of Clinical Chemistry
J Werzowa, M Hecking, M Haidinger, D Döller, A Sharif, A Tura, M D Säemann
Posttransplantation diabetes mellitus (PTDM) is a major complication after renal transplantation due to its negative impact on patient and graft survival, and affects up to 40% of renal transplant recipients. The generation of evidence regarding its optimal treatment is now progressing with some emphasis on early postoperative insulin treatment that targets β-cell failure. This therapy seems to benefit renal transplant patients but contrasts with previous PTDM guidelines that were following treatment of type 2 diabetes mellitus (DM): oral antidiabetics first, insulin last...
May 2015: Current Diabetes Reports
Meirigeng Qi, Valiente Luis, Shiela Bilbao, Keiko Omori, Jeffrey Rawson, Brian McFadden, Jemily Juan, Indu Nair, Yoko Mullen, Mohamed El-Shahawy, Donald Dafoe, Fouad Kandeel, Ismail H Al-Abdullah
Organs from hypernatremia (elevated Na+) donors when used for transplantation have had dismal outcomes. However, islet isolation from hypernatremic donors for both transplantation and research applications has not yet been investigated. A retrospective analysis of in vivo and in vitro islet function studies was performed on islets isolated from hypernatremic (serum sodium levels≥160 meq/l) and normal control (serum sodium levels≤155 meq/l) donors. Twelve isolations from 32 hypernatremic and 53 isolations from 222 normal donors were randomly transplanted into diabetic NOD Scid mice...
March 1, 2015: American Journal of Physiology. Endocrinology and Metabolism
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