Endocrine Management of Renal Transplant Patients: A Role in Successful Graft Survival?

Presentation Number: SUN 630
Date of Presentation: April 2nd, 2017

Jalaja Joseph*1, Stephanie Jou2, Robert Zhang2, David Conti3 and Matthew C Leinung1
1Albany Medical College, Albany, NY, 2Albany Medical College, 3Albany Medical Center, Albany

Abstract

Introduction

Graft survival after renal transplantation is dependent upon multiple factors. Many patients undergoing renal transplantation have endocrine disorders, such as pre-existing diabetes and metabolic bone disease, and can develop diabetes (PTDM) and hyperlipidemia. Diabetes, lipid abnormalities, and hypovitaminosis D have been associated negatively with patient and graft survival1,2. Our transplant center was recently found by the Scientific Registry of Transplant Recipients to have the nation’s highest 3 year graft survival for renal transplants. We hypothesized that our team management of these patients was one factor in this success.

Methods

Over 10 years ago members of our Endocrine division began participating in the weekly transplant clinic in the Department of Surgery in order to facilitate patient care. We analyzed the transplant data which included solitary kidney recipients undergoing transplantation between 1987 and 2016 comprising a total of 626 transplantations. We searched this database for all the patients seen by endocrinology over the past 3 years. The charts were reviewed after IRB approval and data was collected retrospectively.

Results

During this 3 year period a total of 253 patients of the 626 transplant recipients were seen by our division. There were 159 males and 94 females with an average age at transplant of 47.5 years. Diabetes was present prior to transplant in 117 (46%) and an additional 48 (19%) developed PTDM. For patients with diabetes, the pre transplant A1c decreased from 7.5 ± 1.6% to 7.1 ± 1.2% at 6 months (p = 0.13). At 6 months, the A1c was 6.4% for those who had developed PTDM. Pre-transplant, 79 (31%) were on some form of lipid lowering therapy. Post-transplant, 213 (84%) had hyperlipidemia: 173 (68%) were on a statin, in addition to 54 (21%) on fish oil, 30 (12%) on gemfibrozil, and 4 (1.5%) on niacin. The average Vitamin D level within 1 year post-transplant was 19.9 ± 8, but increased to 31.7± 14 at most recent visits (P < .01). Of 217 patients over the age of 40, 93 (43%) have had a DEXA: Osteoporosis was diagnosed in 43 patients and osteopenia in an additional 31. Of these patients, 35 are or have been on treatment (bisphosphonate).

Conclusions:

We believe that multidisciplinary team management of renal transplant recipients can improve graft survival. While our improvement in A1c values at 6 months post-transplant was not statistically significant, the trend was clearly seen even considering potential artefactual lowering of the A1c in renal failure patients. We did demonstrate improvement in Vitamin D levels and frequency of statin use. We also found that there remain some barriers for care evidenced, for example, by many patients not having Vitamin D levels or DEXA.

 

Nothing to Disclose: JJ, SJ, RZ, DC, MCL