Dataset Information

Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.

ABSTRACT: OBJECTIVE:To investigate the role of calcineurin inhibitor exposure and states of insulin resistance-obesity and adolescence-in prediabetes after pediatric liver transplant via oral glucose tolerance testing, which previously has not been done systematically in these at-risk youths. STUDY DESIGN:This was a cross-sectional study of 81 pediatric recipients of liver transplant. Prediabetes was defined as impaired glucose tolerance (IGT; glucose ?140?mg/dL at 2 hours) or impaired fasting glucose (IFG, ?100?mg/dL). Corrected insulin response (CIR) was calculated as measure of insulin secretion, corrected for glucose (CIR30, CIR60, CIR120). RESULTS:Subjects were aged 8.1-30.0 years and 1.1-24.7 years post-transplant; 44% had prediabetes-27% IGT, 14% IFG, and 3% both. IGT was characterized by insulin hyposecretion, with lower CIR60 and CIR120 in IGT than subjects with normal glucose tolerance. Subjects with tacrolimus trough >6?µg/mL at study visit had lower CIR120 than those with trough ?6?µg/mL and those off calcineurin-inhibitors. Mean of tacrolimus troughs preceding the study visit, years since transplant, and rejection episodes were not associated significantly with lower CIR. CIR suppression by tacrolimus was most pronounced >6 years from transplant. Overweight/obese subjects and adolescents who retained normal glucose tolerance had greater CIR than those who were IGT. CONCLUSION:IGT after pediatric liver transplant is driven by inadequate insulin secretion. It is quite common but not detectable with fasting laboratory values-the screening recommended by current guidelines. Calcineurin inhibitors suppress insulin secretion in these patients in a dose-dependent manner. Given the recent focus on long-term outcomes and immunosuppression withdrawal in these children, longitudinal studies are warranted to investigate whether IGT is reversible with calcineurin inhibitor minimization.

SUBMITTER: Perito ER

PROVIDER: S-EPMC5328850 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.

Perito Emily R ER Lustig Robert H RH Rosenthal Philip P

The Journal of pediatrics 20161229

<h4>Objective</h4>To investigate the role of calcineurin inhibitor exposure and states of insulin resistance-obesity and adolescence-in prediabetes after pediatric liver transplant via oral glucose tolerance testing, which previously has not been done systematically in these at-risk youths.<h4>Study design</h4>This was a cross-sectional study of 81 pediatric recipients of liver transplant. Prediabetes was defined as impaired glucose tolerance (IGT; glucose ≥140 mg/dL at 2 hours) or impaired fast ...[more]

PMID: 28041666

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Project description:ImportanceMelanoma risk factors and incidence in renal transplant recipients can inform decision making for both patients and clinicians.ObjectiveTo determine risk factors and characteristics of renal transplant recipients who develop melanoma.Design, setting, and participantsThis cohort study of a large national data registry used a cohort of renal transplant recipients from the United States Renal Data System (USRDS) database from the years 2004 through 2012. Differences in baseline characteristics between those who did and did not develop melanoma were examined, and a survival analysis was performed. Patients with renal transplants who received a diagnosis of melanoma according to any inpatient or outpatient claim associated with a billing code for melanoma were included. A history of pretransplant melanoma, previous kidney transplantation, or transplantation after 2012 or before 2004 were exclusion criteria. The data analysis was conducted from 2015 to 2016.ExposureReceipt of a renal transplant.Main outcomes and measuresIncidence and risk factors for melanoma.ResultsOf 105?174 patients (64?151 [60.7%] male; mean [SD] age, 49.6 [15.3] years) who received kidney transplants between 2004 and 2012, 488 (0.4%) had a record of melanoma after transplantation. Significant risk factors for developing melanoma vs not developing melanoma included older age among recipients (mean [SD] age, 60.5 [10.2] vs 49.7 [15.3] years; P?<?.001) and donors (42.6 [15.0] vs 39.2 [15.1] years; P?<?.001), male sex (71.5% vs 60.7%; P?<?.001), recipient (96.1% vs 66.5%; P?<?.001) and donor (92.4% vs 82.9%; P?<?.001) white race, less than 4 HLA mismatches (44.9% vs 37.1%; P?=?.001), living donors (44.7% vs 33.7%; P?<?.001), and sirolimus (22.3% vs 13.2%; P?<?.001) and cyclosporine (4.9% vs 3.2%; P?=?.04) therapy. Risk factors significant on survival analysis included older recipient age (hazard ratio [HR] per year, 1.06; 95% CI, 1.05-1.06; P?<?.001), recipient male sex (HR, 1.53; 95% CI, 1.25-1.88; P?<?.001), recipient white race, living donors (HR, 1.35; 95% CI, 1.11-1.64; P?=?.002), and sirolimus (HR, 1.54; 95% CI, 1.22-1.94; P?<?.001) and cyclosporine (HR, 1.93; 95% CI, 1.24-2.99; P = .004) therapy. The age-standardized relative rate of melanoma in USRDS patients compared with Surveillance, Epidemiology, and End Results patients across all years was 4.9. A Kaplan-Meier estimate of the median time to melanoma among those patients who did develop melanoma was 1.45 years (95% CI, 1.31-1.70 years).Conclusions and relevanceRenal transplant recipients had greater risk of developing melanoma than the general population. We believe that the risk factors we identified can guide clinicians in providing adequate care for patients in this vulnerable group.

Dataset Information

Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.

Publications

Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors.

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