Pretransplant Risk Score for New-Onset Diabetes After Kidney Transplantation

Pretransplant Risk Score for New-Onset Diabetes After Kidney Transplantation. New-onset diabetes after kidney transplantation (NODAT) has adverse clinical and economic implications. A risk score for NODAT could help identify research subjects for intervention studies.

A risk score computed from seven simple pretransplant variables can identify risk of NODAT.

New-onset diabetes after kidney transplantation (NODAT) occurs frequently in the 1st year after transplant (incidence 15–25%) and has a significant impact on allograft and patient survival, health care costs, and quality of life (1–4). In a large, retrospective study of U.S. Renal Data System data, NODAT was associated with a 60% increase in subsequent graft failure, an almost 90% increase in death rates (3), and frequent diabetes complications (5). NODAT incurs an extra Medicare payment of $21,500 per case by 2 years’ posttransplant (4).

These are compelling reasons for prevention. However, clinical trials of prevention strategies may have greater power if conducted among patients at highest risk. Because the incidence of NODAT is 5 to 6 times higher the 1st year after transplant (15–25%), compared with the annual incidence thereafter (4–6%), pretransplant risk factors may play significant roles in the development of NODAT. Previous studies have identified many risk factors for NODAT including older age, minority race, higher BMI, corticosteroid use, family history of type 2 diabetes (T2DM), hepatitis C seropositivity, male donor, and elevations in pretransplant fasting glucose and triglycerides (1–3).

We previously found inpatient hyperglycemia and its treatment with insulin immediately after transplantation to predict NODAT (6). Ideally, we could identify those at highest risk of NODAT well before transplantation to provide early intervention. Our aim was therefore to construct a risk score for NODAT using simple pretransplant clinical and laboratory tests. Such a score could help identify patients at highest risk of NODAT for intervention or enrollment in prevention clinical trials.