Background: NODAT following SOT is associated with cardiovascular morbidity, poor graft function and patient survival. The incidence of NODAT within first year post-transplant in adults is 15-20% in renal and 10-30% in liver transplant recipients. The incidence of post-transplant hyperglycemia and NODAT after pediatric SOT remains uncertain.
Objective:To determine the incidence of post-transplant hyperglycemia and NODAT in pediatric SOT and the risk per individual organ group.
Methods: All children who underwent SOT from January 1st,2002 to December 31st,2011 were followed till the time of transfer (age of 18 years) or death. Post-transplant hyperglycemia was defined as random blood glucose levels >11.1 mmol/l on two occasions after 14 days of transplant, not requiring further treatment. NODAT was defined according to the American Diabetes Association criteria, requiring treatment. Analyses were performed using the Kaplan-Meier method and Cox proportional hazards model.
Results: Of 459 children, 259 (56.4%) were boys. The population included liver (32.2%), kidney (32%), heart (27.9%), lung (5.4%), and multiple organ (2.4%) transplant recipients. During a mean follow-up of 3.7±2.8 years (median:3.2), 73 (15.9%) recipients developed post-transplant hyperglycemia and 12 (2.6%) progressed to NODAT. The highest incidence of hyperglycemia was seen in multiple organ (54.5%), followed by lung (28%), renal (16.3%), heart (14.1 %), and liver (12.1 %) transplant recipients. The relative hazard for post-transplant hyperglycemia was 1.5 times higher for renal transplant (95% CI: 0.8, 2.8), 1.1 times for heart transplant (95% CI: 0.57, 2.1), 2.4 times for lung transplant (95% CI: 1.0, 5.8) and 7.9 times for multiple organ transplant (95% CI: 3.1, 20.1) as compared to liver transplant recipients.
Conclusions: The incidence of post-transplant hyperglycemia and NODAT is 15.9% and 2.6% respectively, the risk being highest among multiple organ and least in liver transplant patients.
DISCLOSURES:Kim, S.: Grant/Research Support, Astellas Pharma Canada, Novartis Pharma Canada, Genzyme.