Diabete Melito Pós-Transplante em Receptores de Transplante Renal

O diabete melito pos-transplante (DMPT) e uma complicacao relativamente comum e sua ocorrencia esta relacionada principalmente ao uso de imunossupressores. Avaliar a incidencia de diabete melito apos o transplante renal na regiao Oeste do Estado do Parana. Estudamos retrospectivamente os prontuarios de todos os pacientes submetidos a transplante renal em Cascavel-PR. Foram realizados 256 transplantes no periodo de 14/09/1985 a 30/04/2008, sendo 58 com doador falecido e 198 com doador vivo. Foram registrados: idade, sexo, raca, data do transplante, compatibilidade HLA, tipo de doador, doenca basica, tempo de dialise, modalidade dialitica, tempo de isquemia, presenca ou nao de rejeicao aguda, presenca ou nao de necrose tubular aguda, tipo de imunossupressao, evolucao para obito e complicacoes, incluindo o DM pos-transplante. Os dados foram armazenados em banco de dados do programa Microsoft Excel, e foram calculadas as medias das variaveis continuas e as frequencias relativas. Foram excluidos 14 pacientes que apresentavam DM antes do transplante renal. Foi calculada a incidencia de DM pos-transplante. DM pos-transplante foi diagnosticado em 19 (7,9%) pacientes com media de idade de 40,5 ± 14,1 anos, 52,6% foram do sexo masculino, 89,5% da raca branca e o tempo de seguimento foi de 123,8 ± 82,7 meses. O tempo medio de dialise foi 21,3 ± 16,9 meses. Os doadores foram haploidenticos em 49,2% dos casos, identicos em 28,1% e falecidos em 22,7%. Nao houve retransplante. A incidencia de DM pos-transplante renal em nosso estudo foi baixa quando comparada com a literatura.

[1]  K. Safranow,et al.  Autosomal dominant polycystic kidney disease is not a risk factor for post-transplant diabetes mellitus. Matched-pair design multicenter study. , 2008, Archives of medical research.

[2]  M. Žarković,et al.  Glucocorticoid effect on insulin sensitivity: A time frame , 2008, Journal of endocrinological investigation.

[3]  J. Dumortier,et al.  Risk factors for new‐onset diabetes mellitus following liver transplantation and impact of hepatitis c infection : An observational multicenter study , 2007, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[4]  D. Serón,et al.  Posttransplant diabetes mellitus in renal allograft recipients: A prospective multicenter study at 2 years. , 2006, Transplantation Proceedings.

[5]  S. Vera,et al.  Posttransplant diabetes mellitus in liver transplant recipients. , 2006, Progress in transplantation.

[6]  B. Balkau,et al.  The threshold for diagnosing impaired fasting glucose: a position statement by the European Diabetes Epidemiology Group , 2006, Diabetologia.

[7]  A. Hartmann,et al.  The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events. , 2006, Kidney international.

[8]  A. Jeppsson,et al.  New-onset cardiovascular risk factors in lung transplant recipients. , 2005, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[9]  M. Schnitzler,et al.  Guidelines for the treatment and management of new‐onset diabetes after transplantation 1 , 2005, Clinical transplantation.

[10]  P. Marchetti.  New-onset diabetes after transplantation. , 2004, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[11]  R. Balshaw,et al.  New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta‐Analysis , 2004, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[12]  M. Salvadori,et al.  Post-transplant diabetes mellitus. , 2003, Journal of nephrology.

[13]  M. Schnitzler,et al.  Incidence and Cost of New Onset Diabetes Mellitus Among U.S. Wait‐Listed and Transplanted Renal Allograft Recipients , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[14]  Bertram L Kasiske,et al.  Diabetes Mellitus after Kidney Transplantation in the United States , 2003, American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons.

[15]  P. Thuluvath,et al.  Outcome of patients with new‐onset diabetes mellitus after liver transplantation compared with those without diabetes mellitus , 2002, Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society.

[16]  J. Fink,et al.  Risk for posttransplant Diabetes mellitus with current immunosuppressive medications. , 1999, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[17]  J. Neylan.  Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. FK506 Kidney Transplant Study Group. , 1998, Transplantation.

[18]  J. Squifflet,et al.  Multicenter randomized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection - A report of the European Tacrolimus Multicenter Renal Study Group , 1997 .

[19]  G. Nyberg,et al.  Gender differences in a kidney transplant population. , 1997, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[20]  S. Wallenstein,et al.  Higher incidence of diabetes in liver transplant recipients with hepatitis C. , 1998, Journal of clinical gastroenterology.