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  Zanko J Med Sci:  Dec. 2016; 20 (3): 1440-1449

Incidence of post transplant diabetes mellitus in Erbil Teaching Hospital

Osamah Sameer Mahdi*, Safa Ezzidin Al-Mukhtar**, Hama Nejm Jaff***

* Soran Hospital, Ministry of Health, Erbil, Iraq.

** Department of Internal Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq.

*** Kurdistan Board for Medical Specialties, Erbil, Iraq.


Background and objective: The onset of post-transplant diabetes mellitus has been linked to higher rates of cardiovascular disease and infection. The aim of this study was to evaluate the incidence of post renal transplant diabetes. More specifically, they study tried to find out the demography of patients with post transplant diabetes mellitus, their anthropometric measures, the incidence rate in different periods and among different demographic variables.

Methods: Seventy patients transplanted in different centers in Iraq were enrolled in the study. The patients were followed up for more than one year during their visits and or admission to the Dialysis Unit in Erbil Teaching Hospital during the period between 1/12/2006 and 1/4/2008. The statistical package for the social sciences (version 14) was used for data entry and analysis.

Results: Fifty four patients were male and 16 patients were female. Their ages ranged between 14 and 65 years with a mean of 36 years. Thirty one percent of them developed post transplant diabetes mellitus; 14% developed post transplant diabetes mellitus at early while 17% developed post transplant diabetes mellitus at late period. A significant association was found between increased age and triglyceride and post transplant diabetes mellitus.

Conclusion: Post transplant diabetes mellitus is an important complication that the transplant physicians should screen for in every transplanted patient. Increasing age and serum triglyceride levels may be regarded as predictors for the development of post transplant diabetes mellitus.

Keywords: Incidence; Post transplant diabetes mellitus; Hypertension; Erbil; Iraq.


1. Davidson J, Wilkinson A, Dantal J, Dotta F, Haller H, Hernandez D, et al. New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003. Transplantation 2003; 75:SS3-24.

2. Wilkinson A, Davidson J, Dotta F, Philip DH, Paul K, Bryce K, et al. Guidelines for the treatment and management of new-onset diabetes after transplantation. Clin Transplant 2005; 19:291.

3. Heisel O, Heisel R, Balshaw R, Keown P. New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis. Am J Transplant 2004; 4:583.

4. Gunnarsson R, Arner P, Lundgren G, Magnusson G, Ostman J, Groth CG. Diabetes mellitus--a more-common-than-believed complication of renal transplantation. Transplant Proc 1979; 11:1280.

5. Kasiske BL, Snyder JJ, Gilbertson D, Matas, AJ. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003; 3:178.

6. Cosio FG, Pesavento TE, Osei K,  Henry ML, Ferguson MR. Post-transplant diabetes mellitus: increasing incidence in renal allograft recipients transplanted in recent years. Kidney Int 2001; 59:732.

7. Woodward RS, Schnitzler MA, Baty J, Lowell GA, Lopez-Rocafort L, Haider S, et al. Incidence and cost of new onset diabetes mellitus among U.S. wait-listed and transplanted renal allograft recipients. Am J Transplant 2003; 3:590.

8. Gaston RS, Basadonna G, Cosio FG, Davis CL, Kasiske BL, Larsen J, et al. Transplantation in the diabetic patient with advanced chronic kidney disease: a task force report. Am J Kidney Dis 2004; 44:529.

9. Boudreaux JP, McHugh L, Canafax DM, Ascher N, Sutherland DE, Payne W, et al. The impact of cyclosporine and combination immunosuppression on the incidence of posttransplant diabetes in renal allograft recipients. Transplantation 1987; 44:376.

10. Cosio FG, Pesavento TE, Kim S, Osei K, Henry  M, Ferguson RM, et al. Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int 2002; 62:1440.

11. Maes BD, Kuypers D, Messiaen T, Evenepoel P, Mathieu C, Coosemans W, et al. Posttransplantation diabetes mellitus in FK-506-treated renal transplant recipients: analysis of incidence and risk factors. Transplantation 2001; 72:1655.

12. Araki M, Flechner SM, Ismail HR, Flechner LM, Zhou L, Derweesh IH, et al. Posttransplant diabetes mellitus in kidney transplant recipients receiving calcineurin or mTOR inhibitor drugs. Transplantation 2006; 81:335.

13. Friedman AN, Miskulin DC, Rosenberg IH, Levey AS. Demographics and trends in overweight and obesity in patients at time of kidney transplantation. Am J Kidney Dis 2003; 41:480.

14. Sulanc E, Lane JT, Puumala SE, Groggel GC, Wrenshall LE, Stevens RB. New-Onset Diabetes after Kidney Transplantation: An Application of 2003 International Guidelines. Transplantation 2005; 80:945.

15. Walczak D, Calvert D, Jarzembowski T. Increased risk of post-transplant diabetes mellitus despite early steroid discontinuation on Hispanic kidney transplant recipients. Clin Transplant 2005; 19:527.

16. Sumrani NB, Delaney V, Ding Z, Davis R, Daskalakis P, Friedman EA, et al. Posttransplant diabetes mellitus in cyclosporine-treated renal transplant recipients. Transplant Proc 1991; 23:1249.

17. Gourishankar S, Jhangri GS, Tonelli M, Wales LH, Cockfield SM. Development of diabetes mellitus following kidney transplantation: a Canadian experience. Am J Transplant 2004; 4:1876.

18. Bloom RD, Rao V, Weng F, Grossman RA, Cohen D, Mange KC. Association of hepatitis C with posttransplant diabetes in renal transplant patients on tacrolimus. J Am Soc Nephrol 2002; 13:1374.

19. Abbott KC, Lentine KL, Bucci JR, Agodoa LY, Koff JM, Holtzmuller KC, et al. Impact of diabetes and hepatitis after kidney transplantation on patients who are affected by Hepatitis C virus. J Am Soc Nephrol 2004; 15:3166.

20. Fabrizi F, Martin P, Dixit V, Bunnapradist S, Kanwal F, Dulai G. Post-transplant diabetes mellitus and HCV seropositive status after renal transplantation: Meta-analysis of clinical studies. Am J Transplant 2005; 5:2433.

21. Hjelmesaeth J, Midtvedt K, Jenssen T, Hartmann A. Insulin resistance after renal transplantation: impact of immunosuppressive and antihypertensive therapy. Diabetes Care 2001; 24:2121.

22. Helmesaeth J, Sagedal S, Hartmann A, Rollag H, Egeland T, Hagen M, et al. Asymptomatic cytomegalovirus infection is associated with increased risk of new-onset diabetes mellitus and impaired insulin release after renal transplantation. Daibetologia 2004; 47:1550.

23. Hjelmesaeth J, Hartmann A. Insulin resistance in patients with adult polycystic kidney disease. Nephrol Dial Transplant 1999; 14:2521.

24. De Mattos AM, Olyaei AJ, Prather JC, Golconda MS, Barry JM , Norman Dj. Autosomal-dominant polycystic kidney disease as a risk factor for diabetes mellitus following renal transplantation. Kidney Int 2005; 67:714.

25. Hirsch IB, Paauw DS. Diabetes management in special situations. Endocrinol Metab Clin North Am 1997; 26:631.

26. Gurwitz JH, Bohn RL, Glynn RJ, Monane M, Mogun H, Avorn J. Glucocorticoids and the risk for initiation of hypoglycemic therapy. Arch Intern Med 1994; 154:97.

27. Boots JM, Christiaans MH, Van Duijnhoven EM, Van Suylen RJ, Van Hooff JP. Early steroid withdrawal in renal transplantation with tacrolimus dual therapy: a pilot study. Transplantation 2002; 74:1703.

28. Midtvedt K, Hjelmesaeth J, Hartmann A, Lund K, Paulsen D, Egeland T, et al. Insulin resistance after renal transplantation: the effect of steroid dose reduction and withdrawal. J Am Soc Nephrol 2004; 15:3233.

29. Kramer BK, Zulke C, Kammerl MC, Schmidt C, Hengstenberg C, Fischereder M, et al. Cardiovascular risk factors and estimated risk for CAD in a randomized trial comparing calcineurin inhibitors in renal transplantation. Am J Transplant 2003; 3:982.

30. Van Hooff JP, Christiaans MH, van Duijnhoven EM. Tacrolimus and posttransplant diabetes mellitus in renal transplantation. Transplantation 2005; 79:1465.

31. Johnson C, Ahsan N, Gonwa T, Halloran P, Stegall M, Hardy M, et al. Randomized trial of tacrolimus (Prograf) in combination with azathioprine or mycophenolate mofetil versus cyclosporine (Neoral) with mycophenolate mofetil after cadaveric kidney transplantation. Transplantation 2000; 69:834.

32. Weir MR, Fink JC. Risk for posttransplant Diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis 1999; 34:1.

33. Drachenberg CB, Klassen DK, Weir MR, Wiland A, Fink JC, Bartlett ST, et al. Islet cell damage associated with tacrolimus and cyclosporine: morphological features in pancreas allograft biopsies and clinical correlation. Transplantation 1999; 68:396.

34. Sulanc E, Lane J, Puumala S, Groggel, Gerald C, Wrenshall LE, et al. New-onset diabetes after kidney transplantation: An application of 2003 International Guidelines. Transplantation 2005; 80:945.

35. Teutonico A, Schena P, Di Paolo S. Glucose metabolism in renal transplant recipients: effect of calcineurin inhibitor withdrawal and conversion to sirolimus. J Am Soc Nephrol. 2005; 16:3121.

36. Miller J, Mendez R, Pirsch JD, Jensik SC. Safety and efficacy of tacrolimus in combination with mycophenolate mofetil (MMF) in cadaveric renal transplant recipients. FK506/MMF Dose-Ranging Kidney Transplant Study Group. Transplantation 2000; 69:875.

37. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157(21): 2413-46.

38. AL-Windawi SB, Rasheed JI, Allawi AA. Diabetes mellitus after renal transplantation. IPMJ 2004; 3 (1): 69-73.

39. Roth D, Milgrom M, Esquenazi V, Fuller L, Burke G, Miller J. Post transplant hyperglycemia. Increased incidence in cyclosporine-treated renal allograft recipients. Transplantation 1989; 47:278.

40. Vesco, L, Busson, M, Bedrossian, J, Bitker M O, Hiesse C, Lang P. Diabetes mellitus after renal transplantation: characteristics, outcome, and risk factors. Transplantation 1996; 61:1475.

41. Gursoy M, Koksal R, Karavelioglu D,  Colak G, Gür N, Özdemir S, et al. Pretransplantation alpha-interferon therapy and the effect of hepatitis C virus infection on kidney allograft recipients. Transplant Proc 2000; 32:580.

42. Ducloux D, Motte G, Vautrin P, Bresson-Vautrin C, Rebibou JM, Chalopin JM, et al. Polycystic kidney disease as a risk factor for post-transplant diabetes mellitus. Nephrol Dial Transplant 1999; 14:1244.

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