Hypertension and nephrology

[Early histopathological changes in new onset diabetes mellitus after renal transplantation]

IBRAHIM Munir Yasmin1, BORDA Bernadett1, LENGYEL Csaba2, VÁRKONYI Tamás2, KEMÉNY Éva3, SZABÓ Viktor4, KUBIK András5, LÁZÁR György1

DECEMBER 10, 2013

Hypertension and nephrology - 2013;17(05-06)

[Introduction: New-onset diabetes after transplantation (NODAT) is one of the most common complications following kidney transplantation. The diagnosis of NODAT is often late or missed, therefore it impairs the implanted renal allograft. Patients and methods: Patients were randomized to receive cyclosporine A- or tacrolimusbased immunosuppression. One year after the transplantation, fasting and oral glucose tolerance tests were performed, and the patients were assigned to one of the following three groups based on the results: normal, impaired fasting glucose/impaired glucose tolerance (IFG/IGT), NODAT. Age, laboratory results, renal function, morphological abnormalities, and changes in the Banff score were evaluated. Results: NODAT developed in 14% of patients receiving cyclosporine A-based immunosuppression and in 26% of patients taking tacrolimus (p=0.0002). Albumin levels were similar, but uric acid level (p=0.002) and the age of the recipient (p=0.003) were significantly different between the diabetic and the normal group. The evaluation of renal function showed no significant differences in case of serum creatinine level, eGFR, and urea level. Evaluation of tissue samples revealed that acute cellular rejection (ACR) and interstitial fibrosis/ tubular atrophy (IF/TA) were significantly different in the NODAT group. Changes in the Banff score provided significant difference regarding tubulitis (“t”) and interstitial inflammation (“i”) (p=0.05). Discussion: The pathological effect of new-onset diabetes after kidney transplantation can be detected in the morphology of the renal allograft earlier, before any signs of functional impairment.]

AFFILIATIONS

  1. Szegedi Tudományegyetem, ÁOK, Sebészeti Klinika, Szeged
  2. Szegedi Tudományegyetem, ÁOK, I. Sz. Belgyógyászati Klinika, Szeged
  3. Szegedi Tudományegyetem, ÁOK, Patológia Intézet, Szeged
  4. Szegedi Tudományegyetem, ÁOK, Családorvosi Intézet, Szeged
  5. Semmelweis Egyetem, Urológiai Klinika, Budapest

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