Evaluation of Microvascular Complications in Kidney Recipients With Posttransplant Diabetes Mellitus

医学 糖尿病 内科学 视网膜病变 糖尿病性视网膜病变 周围神经病变 肾病 外科 胃肠病学 内分泌学
作者
Başak Çelik Kavaklılar,O Ozdemir,Tolga Yıldırım,Özlem Dikmetaş,Hilal Toprak,Vedat Hekimsoy,Alperen Onur İşler,Rahmi Yılmaz,Sibel Kadayıfçılar,Yunus Erdem,Tomris Erbaş,Uğur Ünlütürk
出处
期刊:The Journal of Clinical Endocrinology and Metabolism [Oxford University Press]
卷期号:109 (8): e1623-e1633 被引量:2
标识
DOI:10.1210/clinem/dgad738
摘要

Abstract Context The paucity of data on microvascular complications in patients with posttransplant diabetes (PTDM) is an obstacle to developing follow-up algorithms. Objective To evaluate diabetic microvascular complications in patients with long-standing PTDM. Methods In patients with ≥5-year history of PTDM and age-matched renal transplant recipients without PTDM (NDM), diabetic peripheral neuropathy was evaluated using the Michigan Neuropathy Screening Instrument, the CASE IV device, and in vivo corneal confocal microscopy (CCM). Cardiac autonomic neuropathy tests were performed using heart rate variability. Nephropathy screening was assessed using spot urine albumin/creatinine ratio and eGFR calculation. Diabetic retinopathy was evaluated by fundus examination and photography, and optical coherence tomography. Results This study included 41 patients with PTDM and 45 NDM patients. The median follow-up was 107.5 months in the PTDM group. Peripheral neuropathy was significantly higher in the PTDM group than in the NDM group (P = .02). In the PTDM patients with peripheral neuropathy, corneal nerve fiber density examined by CCM was significantly lower than in PTDM patients without neuropathy (P = .001). Parasympathetic involvement was observed in 58.5% of the PTDM group and 22% of the NDM group (P = .001). Sympathetic involvement was present in 65.9% of the PTDM group and 29.3% of the NDM group (P = .001). Retinopathy was observed in 19.5% of patients in the PTDM group and in none of the NDM patients (P < .001). Renal functions were similar between the study groups. Conclusion Cardiac autonomic neuropathy and diabetic retinopathy can affect patients with PTDM at a high rate. Diabetic retinopathy is a threat to the vision of PTDM patients. Diabetic peripheral neuropathy can be detected early in PTDM patients by CCM.
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