[Risk factors for new-onset diabetes after transplantation in kidney transplant recipients: own data and...

To compare risk factors for new-onset diabetes after transplantation (NODAT) among renal transplant recipients (RTRs) from 1989 to 2018 in the City Clinical Hospital №52, with a systematic analysis of published studies on this topic.

In a 30-year (1989-2018) retrospective study, we found statistically significant differences in age, gender, polycystic kidney disease, cadaveric kidney, cyclosporine, i-mTOR, and steroids between two groups of recipients with and without NODAT. Patients with NODAT were older, more male, more likely to have polycystic kidney disease and deceased donor kidneys, and more likely to be treated with cyclosporine, i-mTOR, and steroids (p<0.05). We conducted a meta-analysis to evaluate the impact of these indicators on the development of NODAT. MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials were searched for eligible case-control studies of risk factors for NODAT in RTRs published between 1990 and 2019. Meta-analysis of proportions was performed using the Freeman-Tukey transformation to calculate weighted summary proportions from a fixed and random effects model.

A total of 13 case-control studies were included in the meta-analysis. Of the total 849 studies found, 13 were included in the systematic review and meta-analysis, including ours, with a total of n=6797 RTRs, of which n=1305 patients with NODAT and n=5492 without NODAT. A wide range of data was recorded for the analysis of the incidence of NODAT (6.5-50.7%), with an average of 17.9% (fixed model) or 24.3% (random model). The proportion of NODAT recorded in the Russian registry of the City Clinical Hospital №52 was lower (11.5%), however, the data in the analyzed studies were highly heterogeneous: I²=98.14%, 95% CI: from 97.61 to 98.55, p<0.0001, Begg's test (p=0.05) and Egger's test (p=0.01) do not exclude the presence of publication bias in this case. Data on NODAT risk factors were less heterogeneous. This meta-analysis showed that age, polycystic kidney disease, i-mTOR and steroid therapy were associated with NODAT, whereas gender, calcineurin inhibitor use, and cadaveric kidney were not. There was no evidence of selection bias in any of the cases.

Risk factors for NODAT in kidney transplant recipients include older age, polycystic kidney disease, i-mTOR and steroid therapy, which initiate a state of insulin resistance. To reduce the risk of NODAT, the possibility of modifying immunosuppression regimens and the use of drugs that reduce insulin resistance and have a nephroprotective effect in RTRs should be considered. Therefore, randomized studies are needed to evaluate SGLT2 inhibitor in RTRs.