Santos AH, et al. - An examination was performed of adult kidney transplant recipients (KTRs) in order to determine the risk of new-onset diabetes after transplantation (NODAT) associated with viral serologies and immunosuppression regimens [tacrolimus (Tac) + mycophenolate (MPA), cyclosporine (CSA) + MPA, sirolimus (SRL) + MPA, SRL + CSA or SRL +Tac]. It was illustrated in findings that risk of developing NODAT in KTRs may be modified via tailoring immunosuppression regimen on the basis of hepatitis C virus (HCV) or cytomegalovirus (CMV) serology.

Methods

• Using Cox regression models, researchers assessed the risk of NODAT in the first posttransplant year associated with: (i) CSA + MPA, SRL + MPA, SRL + MPA or SRL + Tac versus reference, Tac + MPA; (ii) pretransplant viral serology [+ or -; hepatitis B core (HBc), hepatitis C (HCV), cytomegalovirus (CMV) or Epstein Barr Virus (EBV)]; and (iii) interactions between immunosuppression regimens and the viral serology found significant in the main analysis.

Results

• Researchers studied adult KTRs (n = 97 644) from January 1995 through September 2015.
• They found that HCV+ [hazard ratio (HR) 1.50, 95% confidence interval (CI) 1.31–1.68] or CMV+ (HR 1.12, 95% CI 1.06–1.19) serology conferred risk for NODAT, whereas, HBc+ (HR 1.04, 95% CI 0.95–1.15) or EBV+ (HR 1.06, 95% CI 0.97–1.15) serology did not.
• Findings demonstrated that, irrespective of associated HCV or CMV serology, risk of NODAT relative to the reference regimen (Tac + MPA) was lower with CSA + MPA [HCV-: HR 0.74, 95% CI 0.65–0.85; HCV+: HR 0.47, 95% CI 0.28–0.78; CMV-: CSA + MPA HR 0.68, 95% CI 0.54–0.86; CMV+: (CSA + MPA) HR 0.73, 95% CI 0.63–0.85] and similar with SRL + CSA or SRL + MPA.
• In addition, data indicated that in KTRs with HCV- or CMV+ serology, SRL + Tac was associated with a higher risk of NODAT relative to reference [HCV- (HR 1.43, 95% CI 1.17–1.74) and CMV+ (HR 1.44, 95% CI 1.14–1.81), respectively].
• With Tac + MPA, the risk for NODAT-free graft loss was lower when compared with other regimens.