Background: New-onset diabetes after transplantation -(NODAT) is a frequent complication after heart transplantation (HT) and is associated with graft loss and patient survival. Objectives: The aim of this study was to identify the incidence and associated factors contributing to NODAT in Chinese heart transplant recipients. Methods: Adult patients without diabetes mellitus before HT were enrolled in this study. NODAT was diagnosed according to the criteria recommended by the American Diabetes Association. The cumulative incidence was determined at 3, 6, and 12 months, respectively. The risk factors of NODAT were estimated by logistic regression analysis. Results: A total of 154 adults who first received HT were included. Among them, 50 (32.5%) recipients were diagnosed with NODAT after a median follow-up time of 611 days. The cumulative incidence of NODAT was 27.3% at 3 months, 29.9% at 6 months, and 30.5% at 12 months, respectively. Independent risk factors for NODAT included age ≥45 years (OR 3.82, 95% CI 1.57–9.31; p = 0.003), hypertension (OR 3.28, 95% CI 1.17–9.20; p= 0.024), and transient hyperglycemia (OR 12.13, 95% CI 3.35–43.92; p < 0.001). Moreover, recipients treated with both acarbose and insulin for transient hyperglycemia had a significantly higher prevalence of NODAT than those without any anti-diabetic agents (OR 5.35, 95% CI 1.21–23.64; p = 0.027). Conclusions: Age ≥45 years, hypertension, transient hyperglycemia, and associated treatment strategies are imperative to identify recipients at high risk of developing -NODAT.

Keywords:
Heart transplantation, New-onset diabetes after transplantation, Risk factors
1.
Shivaswamy V, Boerner B, Larsen J. Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes.
Endocr Rev
. 2016 Feb;37(1):37–61.
2.
Yusen RD, Edwards LB, Kucheryavaya AY, Benden C, Dipchand AI, Dobbels F, et al.; International Society for Heart and Lung Transplantation. The registry of the International Society for Heart and Lung Transplantation: thirty-first adult lung and heart-lung transplant report–2014; focus theme: retransplantation.
J Heart Lung Transplant
. 2014 Oct;33(10):1009–24.
3.
Baron PW, Infante S, Peters R, Tilahun J, Weissman J, Delgado L, et al. Post-transplant diabetes mellitus after kidney transplant in hispanics and caucasians treated with tacrolimus-based immunosuppression.
Ann Transplant
. 2017 May;22:309–14.
4.
Kim HJ, Jung SH, Kim JJ, Yun TJ, Kim JB, Choo SJ, et al. New-onset diabetes mellitus after heart transplantation　– incidence, risk factors and impact on clinical outcome.
Circ J
. 2017 May;81(6):806–14.
5.
Cehic MG, Nundall N, Greenfield JR, Macdonald PS. Management strategies for posttransplant diabetes mellitus after heart transplantation: a review.
J Transplant
. 2018 Jan;2018:1025893.
6.
Castedal M, Skoglund C, Axelson C, Bennet W. Steroid-free immunosuppression with low-dose tacrolimus is safe and significantly reduces the incidence of new-onset diabetes mellitus following liver transplantation.
Scand J Gastroenterol
. 2018 Jun;53(6):741–7.
7.
American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes–2018.
Diabetes Care
. 2018 Jan;41(suppl 1):S13–27.
8.
Ling Q, Xu X, Xie H, Wang K, Xiang P, Zhuang R, et al. New-onset diabetes after liver transplantation: a national report from China Liver Transplant Registry.
Liver Int
. 2016 May;36(5):705–12.
9.
Saigi-Morgui N, Quteineh L, Bochud PY, Crettol S, Kutalik Z, Mueller NJ, et al.; Swiss Transplant Cohort Study. Genetic and clinic predictors of new onset diabetes mellitus after transplantation.
Pharmacogenomics J
. 2019 Feb;19(1):53–64.
10.
Xie L, Tang W, Wang X, Wang L, Lu Y, Lin T. Pretransplantation risk factors associated with new-onset diabetes after living-donor kidney transplantation.
Transplant Proc
. 2016 Dec;48(10):3299–302.
11.
McCaughan JA, McKnight AJ, Maxwell AP. Genetics of new-onset diabetes after transplantation.
J Am Soc Nephrol
. 2014 May;25(5):1037–49.
12.
Cheng Y, Li H, Yang L, Meng Y, Liu Q, Li X, et al. The incidence and risk factors for new-onset diabetes after transplantation in kidney allograft recipients.
Int J Clin Exp Med
. 2016;9(11):22250–8.
13.
Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine.
Nephron
. 1976;16(1):31–41.
14.
Huang JW, Famure O, Li Y, Kim SJ. Hypomagnesemia and the risk of new-onset diabetes mellitus after kidney transplantation.
J Am Soc Nephrol
. 2016 Jun;27(6):1793–800.
15.
Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al.; International Society of Heart and Lung Transplantation Guidelines. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients.
J Heart Lung Transplant
. 2010 Aug;29(8):914–56.
16.
Chakkera HA, Knowler WC, Devarapalli Y, Weil EJ, Heilman RL, Dueck A, et al. Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus.
Clin J Am Soc Nephrol
. 2010 Sep;5(9):1669–75.
17.
Sharif A, Hecking M, de Vries AP, Porrini E, Hornum M, Rasoul-Rockenschaub S, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions.
Am J Transplant
. 2014 Sep;14(9):1992–2000.
18.
Park SC, Yoon YD, Jung HY, Kim KH, Choi JY, Park SH, et al. Effect of transient post-transplantation hyperglycemia on the development of diabetes mellitus and transplantation outcomes in kidney transplant recipients.
Transplant Proc
. 2015 Apr;47(3):666–71.
19.
Pham PT, Pham PM, Pham SV, Pham PA, Pham PC. New onset diabetes after transplantation (NODAT): an overview.
Diabetes Metab Syndr Obes
. 2011;4:175–86.
20.
Penfornis A, Kury-Paulin S. Immunosuppressive drug-induced diabetes.
Diabetes Metab
. 2006 Dec;32(5 Pt 2):539–46.
21.
Ye X, Kuo HT, Sampaio MS, Jiang Y, Reddy P, Bunnapradist S. Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients.
Transplantation
. 2010 Jun;89(12):1526–32.
22.
Ye F, Ying-Bin X, Yu-Guo W, Hetzer R. Tacrolimus versus cyclosporine microemulsion for heart transplant recipients: a meta-analysis.
J Heart Lung Transplant
. 2009 Jan;28(1):58–66.
23.
Han E, Kim MS, Kim YS, Kang ES. Risk assessment and management of post-transplant diabetes mellitus.
Metabolism
. 2016 Oct;65(10):1559–69.
24.
Seifi S, Rahbar M, Lessan-Pezeshki M, Khatami MR, Abbasi MR, Mahdavi-Mazdeh M, et al. Posttransplant diabetes mellitus: incidence and risk factors.
Transplant Proc
. 2009 Sep;41(7):2811–3.
25.
Cosio FG, Kudva Y, van der Velde M, Larson TS, Textor SC, Griffin MD, et al. New onset hyperglycemia and diabetes are associated with increased cardiovascular risk after kidney transplantation.
Kidney Int
. 2005 Jun;67(6):2415–21.
26.
Nagaraja P, Ravindran V, Morris-Stiff G, Baboolal K. Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation.
Transpl Int
. 2013 Mar;26(3):273–80.
27.
Kawahito S, Kitahata H, Oshita S. Problems associated with glucose toxicity: role of hyperglycemia-induced oxidative stress.
World J Gastroenterol
. 2009 Sep;15(33):4137–42.
28.
Hecking M, Haidinger M, Döller D, Werzowa J, Tura A, Zhang J, et al. Early basal insulin therapy decreases new-onset diabetes after renal transplantation.
J Am Soc Nephrol
. 2012 Apr;23(4):739–49.
29.
Rodrigo E, Fernández-Fresnedo G, Valero R, Ruiz JC, Piñera C, Palomar R, et al. New-onset diabetes after kidney transplantation: risk factors.
J Am Soc Nephrol
. 2006 Dec;17(12 Suppl 3):S291–5.
30.
Gourishankar S, Jhangri GS, Tonelli M, Wales LH, Cockfield SM. Development of diabetes mellitus following kidney transplantation: a Canadian experience.
Am J Transplant
. 2004 Nov;4(11):1876–82.
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2019
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