BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-t...BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-transplant setting suggest an association between the plasma 25-hydroxyvitamin D[25(OH)D]level and onset of type 2 diabetes mellitus.Literature is very limited in the context of PTDM.AIM To study the relationship between vitamin D deficiency at the time of kidney transplant and PTDM in the post-transplant period.METHODS In this single center study,72 patients who underwent kidney transplant were included.Blood samples for serum vitamin D level were collected on the day of transplant and analyzed at the end of study.The LIAISON®25(OH)D assay was used for quantitative estimation of total 25(OH)D in the serum.PTDM was diagnosed by either fasting plasma glucose(>126 mg/dL),2-h post prandial plasma glucose(>200 mg/dL),or 2-h oral glucose tolerance test after 45 days post-transplant.Hemoglobin A1c was not used to diagnose PTDM.Vitamin D levels were labeled as sufficient(≥30.0 ng/mL),insufficient(20.0-29.9 ng/mL),and deficient(<20.0 ng/mL).Patients were reviewed at 45 days and 1 year post transplant for the occurrence of PTDM.RESULTS In our study cohort 72 patients completed the study.Overall,32(43.8%)patients developed PTDM during the follow up of 1 year,44(61.1%)patients had deficient(<20 ng/mL)25(OH)D levels.Twenty-six(81.2%)patients with PTDM had deficient vitamin D levels as compared with 18(45.0%)patients without PTDM(P=0.007).This association was also significant when univariable[odds ratio(OR)=5.3,95%confidence interval(CI):1.79-15.67,P=0.003)]and multivariable(OR=8.21,95%CI:2.19-30.75,P=0.002)regression analysis was performed.A higher proportion of subjects having PTDM(15.6%)had a positive family history of diabetes mellitus than the controls(2.5%)(P=0.045).However,this association did not persist in the multivariable regression analysis(OR=12.6,95%CI:0.86-185.4,P=0.065).CONCLUSION Deficient vitamin D levels(<20 ng/mL)were significantly associated with PTDM in the post kidney transplant setting.Further studies are needed to see the effect of vitamin D replacement on PTDM.展开更多
文摘BACKGROUND Post-transplant diabetes mellitus(PTDM)adversely affects graft survival and is an independent predictor of adverse cardiovascular events.Observational studies in the general population as well as the post-transplant setting suggest an association between the plasma 25-hydroxyvitamin D[25(OH)D]level and onset of type 2 diabetes mellitus.Literature is very limited in the context of PTDM.AIM To study the relationship between vitamin D deficiency at the time of kidney transplant and PTDM in the post-transplant period.METHODS In this single center study,72 patients who underwent kidney transplant were included.Blood samples for serum vitamin D level were collected on the day of transplant and analyzed at the end of study.The LIAISON®25(OH)D assay was used for quantitative estimation of total 25(OH)D in the serum.PTDM was diagnosed by either fasting plasma glucose(>126 mg/dL),2-h post prandial plasma glucose(>200 mg/dL),or 2-h oral glucose tolerance test after 45 days post-transplant.Hemoglobin A1c was not used to diagnose PTDM.Vitamin D levels were labeled as sufficient(≥30.0 ng/mL),insufficient(20.0-29.9 ng/mL),and deficient(<20.0 ng/mL).Patients were reviewed at 45 days and 1 year post transplant for the occurrence of PTDM.RESULTS In our study cohort 72 patients completed the study.Overall,32(43.8%)patients developed PTDM during the follow up of 1 year,44(61.1%)patients had deficient(<20 ng/mL)25(OH)D levels.Twenty-six(81.2%)patients with PTDM had deficient vitamin D levels as compared with 18(45.0%)patients without PTDM(P=0.007).This association was also significant when univariable[odds ratio(OR)=5.3,95%confidence interval(CI):1.79-15.67,P=0.003)]and multivariable(OR=8.21,95%CI:2.19-30.75,P=0.002)regression analysis was performed.A higher proportion of subjects having PTDM(15.6%)had a positive family history of diabetes mellitus than the controls(2.5%)(P=0.045).However,this association did not persist in the multivariable regression analysis(OR=12.6,95%CI:0.86-185.4,P=0.065).CONCLUSION Deficient vitamin D levels(<20 ng/mL)were significantly associated with PTDM in the post kidney transplant setting.Further studies are needed to see the effect of vitamin D replacement on PTDM.
