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221.
Meltem Sezis Demirci Huseyin Toz Filiz Yılmaz Muhittin Ertilav Gulay Asci Mehmet Ozkahya Aysin Zeytinoglu Deniz Nart Ercan Ok 《Clinical transplantation》2010,24(5):E170-E177
Demirci MS, Toz H, Y?lmaz F, Ertilav M, Asci G, Ozkahya M, Zeytinoglu A, Nart D, Ok E. Risk factors and consequences of post‐transplant diabetes mellitus.Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2010.01247.x.© 2010 John Wiley & Sons A/S. Abstract: Background: The aim of this study is to investigate the clinical course as well as risk factors and prognosis of post‐transplant diabetes mellitus (PTDM). Methods: Five hundred fifty‐five kidney transplant recipients were retrospectively evaluated. PTDM was defined as fasting blood glucose ≥140 mg/dL on at least two consecutive measurements or requirement of oral antidiabetic drug or insulin. Patients with PTDM were divided into subgroups according to time of onset (early; <90 d vs. late, ≥90 d) and duration of diabetes (transient, <90 d vs. sustained ≥90 d). Results: The frequency of PTDM was 18.3%. In multivariate analysis age (p < 0.001), hepatitis C virus (HCV) infection (p < 0.05) and tacrolimus use (p < 0.001) were independent risk factors. Among 220 HCV+ patients, liver biopsy was performed in 158, the histological grade (3.3 ± 2.8 vs. 4.4 ± 3.1) and stage (0.9 ± 1.1 vs. 1.4 ± 1.2) were significantly more severe in patients with PTDM than in non‐diabetics. Incidence of PTDM in patients with severe fibrosis was 46.7%; 19.2% in nil or mild fibrosis (p < 0.05). Patient and graft survival were significantly worse, and cardiovascular events and life‐threatening infection episodes were more frequent in PTDM. Half of the patients had early PTDM, while 30.3% of patients with PTDM showed transient nature. Five‐ and 10‐yr death censored graft survival rates were worse in transient subgroup compared with sustained patients with diabetes (log rank 0.025) whereas there was no difference in outcome between early and late subgroups. Conclusions: Age, tacrolimus, and HCV are independent risk factors for PTDM. PTDM has a negative impact on both patient and graft survival, irrespective of the time of onset and duration of diabetes. 相似文献
222.
Yilmaz M Nart A Sen S Tasli F Uslu A Hur E Ozkahya M Hoscoskun C Toz H 《Nephrology (Carlton, Vic.)》2010,15(6):653-658
Aim: Nephrotoxic potential of mammalian target of rapamycin inhibitors (mTORi) is different from calcineurin inhibitors (CNI). The aim of this study is to investigate the interstitial fibrosis (ci) and tubular atrophy (ct) progression from the baseline to first year under a mTORi‐based, CNI‐free regimen. Methods: Thirty‐five kidney transplant recipients who had to have adequate baseline and first year protocol biopsy were enrolled. Exclusion criteria were: the replacement of CNI at any time; acute deterioration in allograft functions; and serum creatinine level above 3 mg/dL at 12 months. Banff criteria were used for histopathological classification. Progression was defined as delta ci + ct ≥ 2 (difference between 12th month and baseline). Results: Mean age of patients and donors were 34 ± 11 and 49 ± 10 years. Twelve patients had delayed graft function (DGF). The maintenance regimen consisted of sirolimus (n = 24) and everolimus (n = 11) with mycophenolate mofetil and steroids. Incidence of acute rejection was 25.7%. At baseline, the incidence of nil and mild fibrosis were 80% and 20%, respectively. At 12 months, 17.1% of patients had moderate, 40% had mild and 42.9% had nil fibrosis. Histological progression from baseline to first year was present in 34% of patients. In multivariate analysis the presence of DGF (P = 0.018) and deceased donor type (P = 0.011) were the most important predictors for fibrosis progression. Conclusion: Progression of graft fibrosis may be seen in one‐third of patients under a mTORi‐based regimen particularly manifested in deceased donor recipients with subsequent DGF. 相似文献
223.