New onset diabetes after renal transplantation: An experience from a developing country – India

New onset diabetes after transplantation (NODAT) is one of the serious side effects of immunosuppressive medications used in renal transplant recipients. Diabetes in transplantation increases the risk of cardiovascular disease and has adverse outcome on graft and patient survival. The aim of this study was to evaluate the incidence of NODAT in renal transplant recipients, the risk factors for the development of NODAT and its effect on graft and patient survival. Total 210 patients underwent renal transplantation from Jan 2010 to June 2016. Mean follow-up period after renal transplantation was 38.14 + 20.12 months. NODAT was defined as two consecutive fasting blood glucose determinations above 126 mg/dL. Thirty five (16.66%) recipients developed NODAT, the duration of onset of NODAT was 4.22 months (range 1 month to 30 months) after transplantation. All of them required insulin treatment. NODAT disappeared in 3(8.57%) recipients with reduction in tacrolimus dose and conversion to everolimus. Cox-Regression analysis was done to estimate the hazard ratio at confidence interval to assess whether the age more than 50 years, deceased donor, induction therapy, graft dysfunction, graft rejection, tacrolimus toxicity, everolimus based immunosuppression, HCV and CMV infection were risk factors for the development of NODAT. Induction therapy and graft dysfunction had 2 fold increased risk of development of NODAT and tacrolimus toxicity had 4 fold increased risk of development of NODAT. Fungal infection (17.14% Vs 2.28%, P value 0.00) was significantly higher in NODAT group compared to recipients without NODAT. There was no significant difference in 6 months, 1, 2, 3 and 5 years patient survival or the death censored graft survival of recipients with NODAT compared to patients without NODAT.