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Hyperglycemia during the Immediate Period after Kidney Transplantation

Harini A. Chakkera^*, E. Jennifer Weil, Janna Castro, Raymond L. Heilman^*, Kunam S. Reddy, Marek J. Mazur^*, Khaled Hamawi^*, David C. Mulligan, Adyr A. Moss, Kristin L. Mekeel, Fernando G. Cosio^||, and Curtiss B. Cook

Divisions of ^* Nephrology and Transplantation, Endocrinology, and Surgery, Mayo Clinic, Scottsdale, and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, Arizona; and ^|| Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota

Correspondence: Dr. Harini A. Chakkera, Division of Transplantation, Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, AZ 85054. Phone: 480-342-0161; Fax: 480-342-2324; E-mail: chakkera.harini{at}mayo.edu

Background and objectives: Hyperglycemia and new-onset diabetes occurs frequently after kidney transplantation. The stress of surgery and exposure to immunosuppression medications have metabolic effects and can cause or worsen preexisting hyperglycemia. To our knowledge, hyperglycemia in the immediate posttransplantation period has not been studied.

Design, setting, participants, & measurements: We conducted a retrospective, observational study to characterize the prevalence and assess the pharmacologic management of hyperglycemia in kidney transplant recipients who underwent transplantation at our center between June 1999 and December 2006. Data were abstracted from electronic and pharmacy databases.

Results: The study cohort included 424 patients (mean age 51 yr; 58% men; 25% with pretransplantation diabetes). All patients with and 87% without pretransplantation diabetes had evidence of hyperglycemia (bedside glucose 200 mg/dl or physician-instituted insulin therapy), whereas the prevalence of hypoglycemia was low (4.5%). Hyperglycemia was sustained throughout hospitalization. All patients with and 66% without pretransplantation diabetes required insulin at hospital discharge. Patients with pretransplantation diabetes were treated primarily with short-acting insulin during the first 24 h after transplantation but were transitioned to long-acting insulin as the hospital stay progressed.

Conclusions: Investigators have historically attempted to identify hyperglycemia after hospital discharge. Our data indicate that a substantial number of patients without pretransplantation diabetes develop hyperglycemia and require insulin during the hospital phase of their care immediately after kidney transplantation. Prospective studies are needed to delineate factors that contribute to development of new-onset diabetes after transplantation among patients with transient hyperglycemia.