ALT, GGT, and the FLI are predictive of NODAT in RTR.

Veldscholte, G. (Glenn) (2014) ALT, GGT, and the FLI are predictive of NODAT in RTR. thesis, Medicine.

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Abstract

Introduction: New onset diabetes after transplantation (NODAT) is very common in renal transplant recipients (RTR) and is associated with serious complications. Transplant specific risk factors for NODAT are the use of immunosuppressive medication and obesity after transplantation. Together they lead to insulin resistance and subsequently to NODAT. Insulin resistance also causes Non Alcoholic Fatty Liver Disease (NAFLD); hepatic accumulation of fat that is associated with a 2-5 times higher risk of diabetes. The liver enzymes Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Gamma Glu-tamyltransferase (GGT), and the Fatty Liver Index (FLI) are effective markers of NAFLD. Previous re-search shows that these markers can also predict diabetes. In this study we aimed to prospectively in-vestigate whether the liverenzymes GGT and ALT, and the FLI are associated with NODAT in RTR. Materials and methods: RTR were recruited between 2001 and 2003 in our clinic (UMCG). We excluded RTR with diabetes at baseline. Subsequently, baseline measurements were performed and NAFLD was estimated using ALT, GGT, and the FLI. Incidence of NODAT was recorded until April 2012. NODAT was diagnosed based on the criteria of the American Diabetes Association. Results: The study population was composed of 501 RTR (56% men, mean age 50 ± 12 years) at a medi-an [IQR] time of 6.0 [2.6-11.5] years post-transplant. After a median [IQR] follow-up time of 10.1 [9.7-10.4] years 76 (15.2%) RTR developed NODAT. In cox-regression analyses, ALT, GGT, and the FLI were strongly associated with NODAT development. The univariate HR for GGT was 1.37 (95% CI 1.13-1.66, p=0.001), for ALT 1.50 (95% CI 1.24-1.81, p<0.001), and for the FLI 3.40 (95% CI 2.19-5.26, p<0.001). Associations remained significant after adjustments for age, sex, kidney function, immunosuppressive medication, systolic blood pressure, smoking, alcohol consumption, physical exercise, markers of diabe-tes, and components of the metabolic syndrome. Conclusion: ALT, GGT, and the FLI are useful predictors of NODAT in RTR, independent of many known risk factors for diabetes. The FLI outperforms ALT and GGT in the prediction of NODAT in RTR, because of the incorporation of components of the metabolic syndrome, a condition very prevalent in our population.

Item Type:	Thesis (Thesis)
Supervisor name:	Navis, prof. dr. GJ and Zelle, drs. DM
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:54
Last Modified:	25 Jun 2020 10:54
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1475

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