ORIGINAL ARTICLE Risk Factors and Incidence of Posttransplant Diabetes Mellitus in Mexican Kidney Recipients Jorge Andrade-Sierra, a,e Ana M. Contreras, b,e Francisco J. Monteon, a,e Alfredo Celis, c,e Rodolfo Gutierrez, d,e Jose L. Montan ˜ez, a,e Sara Ruelas, a,e Seema Baid-Agrawal, f, * Raymond T. Chung, g, * and The Mexican Cooperative Group for the Study of Hepatitis in Kidney Diseases a Department of Nephrology and Transplant Unit, b State Health Research Coordination, c Clinical Research Unit, Specialties Hospital, West National Medical Center, Mexican Institute of Social Security, Guadalajara, Jalisco, Me ´xico d Department of Internal Medicine, e Mexican Cooperative Group for the Study of Hepatitis in Kidney Disease, Mexican Institute of Social Security, Guadalajara, Jalisco, Me ´xico f Department of Nephrology and Medical Intensive Care, Campus Virchow-Klinikum, Charite ´, Universita ¨tsmedizin Berlin, Berlin, Germany g Gastroenterology Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts Received for publication March 13, 2006; accepted May 2, 2006 (ARCMED-D-06-00097). Background. Many risk factors are associated with the development of posttransplant di- abetes mellitus (PTDM), which has adverse effects on graft and patient survival. We re- port the incidence and risk factors associated with the development of PTDM in Mexican kidney recipients. Methods. In a retrospective cohort study, we included kidney transplants performed be- tween January 1, 1994 and December 31, 2000; all patients were followed up for at least 1 year posttransplantation. PTDM was defined as fasting blood glucose O126 mg/dL on at least two occasions. Statistical analysis included estimation of crude relative risk (RR) with 95% confidence intervals (CI). Adjusted RR and 95% CI by logistic regression were used. Results. We studied 522 kidney recipients. Fifty three (10.1%) cases of PTDM were identified in this cohort. Cumulative dosage of prednisone (PDN) O13 g (RR 7.6, 95% CI 1.5e16.3 p !0.0001) and the presence of $1 acute rejection episodes (RR 3.7, 95% CI 1.2e11.6 p !0.001 were independent risk factors associated with the devel- opment of PTDM. Obesity (RR 2.6, 95% CI 0.8e8.7, p 5 0.083) and age range of 40e49 years (RR 2.0; 95% CI 0.6e7.2, p 5 0.093) were identified as marginal risk factors. Conclusions. The incidence of PTDM in kidney recipients was 10.1% in our population. Cumulative PDN dosage and presence of $1 acute rejection episodes were independent risk factors for the development of PTDM. These results are consistent with prior studies of the diabetogenic effect of the PDN. The relationship between acute rejection and PTDM deserves further investigation in order to learn more about the role that inflamma- tory mechanisms may play in this association. Ó 2006 IMSS. Published by Elsevier Inc. Key Words: Incidence, Posttransplant diabetes mellitus (PTDM), Risk factors, Kidney transplant. Introduction Posttransplant complications in kidney transplant patients have a deleterious effect on both the recipients and the graft itself, increasing morbidity, mortality and expenses in this population. Posttransplant diabetes mellitus (PTDM) occurs mainly as an adverse event associated with immunosup- pressive regimens, even with the newer agents. It is likely that PTDM, a long-term problem, has been underestimated. PTDM is also a risk factor for the development of chronic disease associated with type 1 and type 2 diabetes, includ- ing micro- and macrovascular complications (1,2). The *Senior authors contributed equally to the manuscript. Address reprint requests to: Ana M. Contreras, San Juan de Ulua, No. 1633, Colonia Jardines del Country, Guadalajara, Jalisco, Me ´xico; E-mail: acontreras53@hotmail.com 0188-4409/06 $esee front matter. Copyright Ó 2006 IMSS. Published by Elsevier Inc. doi: 10.1016/j.arcmed.2006.05.004 Archives of Medical Research 37 (2006) 961e966