Low serum mannose-binding lectin as a risk factor for new onset diabetes mellitus after renal transplantation

Infections and new onset diabetes mellitus after transplantation (NODAT) are frequent complications after renal transplantation and may be related to innate immunity alterations. We evaluate the relationship among serum mannose-binding lectin (MBL), chronic inflammation, NODAT, and infection.

Between March 2005 and October 2006, consecutive nondiabetic renal transplant recipients were recruited. MBL, soluble tumor necrosis factor receptor 2, and neutrophil gelatinase-associated lipocalin were determined before transplant and at 1 and 3 months. An oral glucose tolerance test was performed at 3 months.

A total of 125 patients were recruited, and 111 patients had a functioning graft at 3 months. MBL levels remained unchanged after transplantation. Subjects with low MBL (lower tertile) had higher pretransplant soluble tumor necrosis factor receptor 2 (40+/-13 ng/mL vs. 35+/-11 ng/mL; P=0.05) and neutrophil gelatinase-associated lipocalin (638+/-114 ng/mL vs. 553+/-185 ng/mL; P=0.03), an increased incidence of bacterial/fungal infection (P=0.021), and an increased prevalence of NODAT at 3 months (44.4% vs. 22.6%; P=0.01). Multivariate analysis confirmed that MBL was a risk factor for NODAT (relative risk: 3.04, 95% confidence interval: 1.18-7.81; P=0.021) adjusting for age, pretransplant impaired fasting glucose, and body mass index.

Low pretransplant MBL is associated with chronic inflammation, NODAT, and infection.