Dr Harleen Kaur1, DR ANNE DURKAN1, DR SIAH KIM1,2,3, DR ERIC AU4,5, DR HUGH MCCARTHY1,3,6
1Department of Nephrology, The Children’s Hospital At Westmead, Westmead, Australia, 2Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 3Centre for Kidney Research, The Children’s Hospital at Westmead, Westmead, Australia, 4Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, 5Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia, 6Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Biography:
Bio to come
Aim:
To examine the incidence of, and risk factors for, new-onset diabetes after transplant (NODAT) in paediatric kidney transplant recipients.
Background:
NODAT is a significant complication following kidney transplantation, with a prevalence of 18%-30% reported in adult populations. However, it remains under-investigated in paediatric populations.
Methods:
We conducted a retrospective cohort study of paediatric isolated kidney transplant recipients (<18 years) from 1980 to 2023, using the Australia and New Zealand Dialysis and Transplant Registry. Kaplan–Meier survival curves and Cox proportional hazard models were used to identify risk factors for NODAT.
Results:
A total of 1588 patients met the inclusion criteria. The median age at transplant was 12 years (IQR 7–15), 937 (59%) were male, and 882 (56%) received a living donor transplant. NODAT developed in 104 patients (6.5%), with a median time to onset of 14.2 years (IQR 6.1–20.1) after first kidney transplant. Obesity at the initiation of kidney replacement therapy (HR, 95% CI) (3.58, 2.19–5.85, p<0.001), tacrolimus use (3.44, 2.13-5.55, p<0.001), cystic kidney disease (2.73, 1.32–5.66, p<0.007), cystinosis ( 3.80, 1.85–7.81, p<0.001) and each one year increase in age (1.06, 1.02-1.11, p<0.006) were independently associated with an increased risk of NODAT. There was no association between recipient gender, ethnicity or time on dialysis before transplant, and development of NODAT.
Conclusion:
The prevalence of NODAT is lower, and the onset is later, in children post kidney transplant compared to adults. Obesity, tacrolimus and specific primary kidney diseases are risk factors. This study enables better informed counselling pre transplant. It also demonstrates the likely benefit of ongoing risk surveillance and intervention in paediatric recipients, years out from primary transplant.
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