New-onset diabetes after kidney transplantation: can the risk be modified by choosing immunosuppression regimen based on pretransplant viral serology?

作者：Santos Alfonso H. Jr.^*; Chen Chao; Casey Michael J.; Womer Karl L.; Wen Xuerong

来源：Nephrology Dialysis Transplantation, 2018, 33(1): 177-184.

DOI：10.1093/ndt/gfx281

• cyclosporine
• diabetes mellitus
• kidney transplantation
• sirolimus
• tacrolimus

Background. This study aimed to analyze adult kidney transplant recipients (KTRs) for the risk of new-onset diabetes after transplantation (NODAT) associated with viral serologies and immunosuppression regimens [tacrolimus (Tac) + mycophenolate (MPA), cyclosporine (CSA) + MPA, sirolimus (SRL) + MPA, SRL + CSA or SRL+Tac].
Methods. Cox regression models were used to examine the risk of NODAT in the first posttransplant year associated with: (i) CSA+MPA, SRL+MPA, SRL+MPA or SRL+Tac versus reference, Tac+MPA; (ii) pretransplant viral serology [+ or -; hepatitis B core (HBc), hepatitis C (HCV), cytomegalovirus (CMV) or Epstein Barr Virus (EBV)]; and (iii) interactions between immunosuppression regimens and the viral serology found significant in the main analysis.
Results. Adult KTRs (n = 97 644) from January 1995 through September 2015 were studied. HCV+[hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.31-1.68] or CMV + (HR 1.12, 95% CI 1.06-1.19) serology was a risk factor and HBc +(HR 1.04, 95% CI 0.95-1.15) or EBV+(HR 1.06, 95% CI 0.97-1.15) serology was not a risk factor for NODAT. Regardless of associated HCV or CMV serology, risk of NODAT relative to the reference regimen (Tac+MPA) was lower with CSA+MPA [HCV- : HR 0.74, 95% CI 0.65-0.85; HCV+: HR 0.47, 95% CI 0.28-0.78; CMV- : CSA+MPA HR 0.68, 95% CI 0.54-0.86; CMV+: (CSA+MPA) HR 0.73, 95% CI 0.63-0.85] and similar with SRL+CSA or SRL+ MPA. In KTRs with HCV- or CMV+ serology, SRL+Tac was associated with a higher risk of NODAT relative to reference [HCV- (HR 1.43, 95% CI 1.17-1.74) and CMV+(HR 1.44, 95% CI 1.14-1.81), respectively]. The risk for NODAT-free graft loss was lower with Tac+MPA than the other regimens.
Conclusions. Tailoring immunosuppression regimen based on HCV or CMV serology may modify the risk of developing NODAT in KTRs.

• 出版日期2018-1