90th Annual Meeting Abstracts
Retrospective Review of Glycemic Control in Patients Undergoing Renal Transplantation
*Erin C Maynard, M.D., *Deborah Hoch, R.N., *Krista Garrison, MPH, *Mark Parker, M.D, *John Vella, M.D., James Whiting, M.D.
Maine Medical Center, Portland, ME
Objective: Identify the effect of peri-operative glycemic control in kidney transplant patients.
Study Design: A single center retrospective review of 95 patients undergoing renal transplantation between 1/2007 and 9/2008 was performed. All patients received corticosteroids as part of their immunosuppressive regimen. Glucose levels in the PACU, on POD 1, and at discharge, were reviewed and correlated with clinical outcomes.
Setting: Single tertiary care center.
Participants: All Kidney alone transplants.
Main Outcome Measures: Length of stay, new onset diabetes after transplant, post operative graft dysfunction, and one year graft survival.
Results: The overall incidence of New Onset Diabetes after Transplant (NODAT) was 24% (15 of 61 patients at risk). Only 13 patients overall had normal blood sugars and tight glycemic control by POD1. Twenty patients (21%) still had glucoses outside of tight control at discharge, including 10 patients who did not carry a diagnosis of diabetes pretransplant. Poor early glucose control in the PACU predicted increased length of stay (6.3 0.4 days vs. 9.5 1.6 days). Patients with poor early glucose control tended to have a higher incidence of NODAT but this did not reach statistical significance (17.8% vs. 33.3%, p=NS). The incidence of graft dysfunction and one year patient survival was not influenced by glycemic control.
Conclusions: Tight glycemic control is uncommon in corticosteroid treated kidney transplant recipients. Poor early glucose control is associated with increased length of stay and may have some predictive value for the development of NODAT. Poor early glucose control does not seem to negatively influence early graft function. Further studies of glycemic control in transplant recipients examining outcomes such as infections or surgical complications may be warranted.