ABSTRACT
Diabetes mellitus is a major cause of morbidity and mortality and is the leading cause of
end-stage renal disease worldwide. New onset diabetes post renal transplantation is
associated with reduced graft function, decreased patient survival and increased risk of
graft loss. The immunosuppressive regimes used and dosage of corticosteroid therapy
appear to impact on the incidence of new onset diabetes post renal transplantation.
The objectives of this study were: to ascertain the prevalence of new onset diabetes post
transplantation; to determine the association between new onset diabetes with
immunosuppressive regimens and ethnicity; and to assess outcomes in terms of morbidity
and mortality.
The study design consisted of a retrospective analysis of 398 patient files transplanted
between 01/07/1994 and 30/06/2004. Information retrieved from the files consisted of
patient demographics ( age, race, gender ), weight, date of onset of diabetes,
immunosuppressive regimens used, infections, cardiovascular and overall morbidity and
mortality. The diagnosis of diabetes was based on the American Diabetes Association
(ADA) criteria or the requirement for anti-diabetic agents.
Results obtained showed that 15.58% (62/398) of patients became diabetic. The mean
time to onset of diabetes was 22.9 months ( range 1 week to 100 months ). 20.21% Black
patients (p=0.100), 9.42% White, 12.5% Coloured and 12% Indian patients became
diabetic. Treatment with Cyclosporine( CyA) had an incidence of diabetes of 14.44%,
Tacrolimus 20.25% p = 0.228, Rapamune 11.36% and Mycophenolate Mofetil 11.97%.
Infections occurred in 96.77% of diabetic patients, p = <0.0001. Cardiovascular
morbidity and mortality was 11.29%, p = 0.82. Overall mortality was 79.3% in the
diabetic group p = 0.237, HR 1.45.
In conclusion, the incidence of new onset diabetes is significant as it confers a higher risk
of infections and overall mortality. Black patients are more affected, with an increased
risk for those treated with Tacrolimus.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6094 |
| Date | 12 February 2009 |
| Creators | Harrichund, Pretissha |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf, application/pdf |
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