Incidence and Risk Factors of New-Onset Diabetes Mellitus After Renal Transplantation Y.-S. Chien, Y.-T. Chen, C.-H. Chuang, Y.-T. Cheng, F.-R. Chuang, and H. Hsieh ABSTRACT Purpose. New-onset diabetes mellitus (PTDM), a major metabolic complication after renal transplantation, examined for incidence and risk factors. Methods. The records of 358 renal transplant recipients with functioning grafts, from 1986 to 2006, were categorized into two groups according to the usage of tacrolimus (FK): FK-based (n = 120 patients) and non–FK-based (n = 238). Using Kaplan-Meier survival analysis and a Cox regression model, this study analyzed the cumulative incidence of PTDM and risk factors, including gender, age, and presence of hepatitis. Results. Cumulative incidences of PTDM after 1, 3, and 5 years posttransplantation in the FK-based group were 11%, 18%, and 22%, respectively. In the non–FK-based group, the cumulative incidences were 5%, 9%, and 12% (P = .01). Taking into account the risk factors, the cumulative incidence of PTDM was significant among patients 51 years or older (odds ratio, 3.965; P = .005), but not with regard to gender or presence of hepatitis B and/or C. Overall cumulative incidence of PTDM in our series was 15% (54/358), including 44% (24/54) of cases that occurred within 1 year after renal transplantation. Conclusion. FK is more diabetogenic than cyclosporine or sirolimus. Older age (51 years) is a significant risk factor, in contrast to hepatitis and gender. About half of these cases of PTDM occurred within 1 year after transplantation. These results suggest that aggressive monitoring of blood sugar is necessary for early detection of PTDM. N EW-ONSET diabetes mellitus (PTDM) is a major metabolic post transplant complication that predis- poses patients to graft dysfunction, infection, and cardio- vascular disease, 1,2 adversely affecting patient and graft survivals. 3 PTDM is associated with the use of immunosup- pressants as well as patient gender, age, and presence of hepatitis B and/or C. The rate of PTDM varies in different renal transplant programs because there has been no uniform definition for its diagnosis. 4,5 The aim of this study was to determine the incidence and risk factors for PTDM. PATIENTS AND METHODS We retrospectively reviewed the medical records of 358 renal transplant recipients with functioning grafts who were transplanted between August 1986 and July 2006. We selected recipients with no known diabetes mellitus before transplantation. The characteristics of patients were recorded as mean values  standard deviation (SD), as summarized in Table 1. Patients were categorized into subgroups according to their most recent immunosuppressive regimen as summarized in Table 2. PTDM was defined as the presence of classic symptoms with casual glucoses 200 mg/dL and/or fasting glucose 126 mg/dL, with a duration of 1 month. Kaplan-Meier survival analysis and Cox regression models were used to analyze the incidence and risk factors for PTDM, including gender, age, and hepatitis B and/or C. The date of the first PTDM event posttransplantation was the basis for calculating PTDM-free survival by both Kaplan-Meier and Cox survival plots. From the Renal Transplant Program, Departments of Nephrol- ogy (Y.-S.C., C.-H.C., F.R.C.) and Urology (Y.-T.Chen, Y.-T.Cheng), Chang Gung Memorial Hospital -Kaohsiung Medical Center, Chang Gung University College of Medicine and in Private Practice (H.H.), Kaohsiung, Taiwan. Address reprint requests to Yu-Shu Chien, MD, Department of Nephrology, Chang Gung Memorial Hospital -Kaohsiung Medi- cal Center, No.123, Ta Pei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan. E-mail: chienys@adm.cgmh.org.tw © 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2008.06.034 Transplantation Proceedings, 40, 2409 –2411 (2008) 2409