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<101>
Unique Identifier
28893559
Title
Twenty-four hour urinary cortisol excretion and the metabolic syndrome in prednisolone-treated renal
transplant recipients.
Source
Steroids. 127:31-39, 2017 11.
VI 1
Record Owner
From MEDLINE, a database of the U.S. National Library of Medicine.
Status
MEDLINE
Authors
de Vries LV; de Jong WHA; Touw DJ; Berger SP; Navis G; Kema IP; Bakker SJL.
Authors Full Name
de Vries, Laura V; de Jong, Wilhelmina H A; Touw, Daan J; Berger, Stefan P; Navis, Gerjan; Kema, Ido
P; Bakker, Stephan J L.
Institution
de Vries, Laura V. Department of Internal Medicine, University Medical Center Groningen, University of
Groningen, Groningen, The Netherlands. Electronic address: L.V.de.Vries@umcg.nl.
de Jong, Wilhelmina H A. Department of Laboratory Medicine, University Medical Center Groningen,
University of Groningen, Groningen, The Netherlands.
Touw, Daan J. Department of Clinical Pharmacy and Pharmacology, University Medical Center
Groningen, University of Groningen, Groningen, The Netherlands.
Berger, Stefan P. Department of Internal Medicine, University Medical Center Groningen, University of
Groningen, Groningen, The Netherlands.
Navis, Gerjan. Department of Internal Medicine, University Medical Center Groningen, University of
Kema, Ido P. Department of Laboratory Medicine, University Medical Center Groningen, University of
Bakker, Stephan J L. Department of Internal Medicine, University Medical Center Groningen, University
of Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The
Netherlands.
Local Messages
Titulo en Biblioteca "Dr J.J. IZQUIERDO", " 1985 - "
MeSH Subject Headings
Female
Humans
*Hydrocortisone/ur [Urine]
Hypothalamus/de [Drug Effects]
*Kidney Transplantation
Male
*Metabolic Syndrome/ci [Chemically Induced]
*Metabolic Syndrome/ur [Urine]
Middle Aged
Pituitary Gland/de [Drug Effects]
*Prednisolone/ae [Adverse Effects]
Time Factors
Keyword Heading
*Cardiovascular disease
*HPA-axis
*Kidney transplantation
*Metabolic syndrome
*Prednisolone
*Urinary cortisol excretion
Abstract
Chronic prednisolone treatment in renal transplant recipients (RTR) causes metabolic abnormalities,
which cluster in the metabolic syndrome (MS). It also suppresses the hypothalamic-pituitaryadrenal (HPA)-
axis. We investigated whether HPA-axis suppression, as measured by 24h urinary cortisol excretion, is
associated with presence of the MS and its individual components, in outpatient RTR with a functioning
graft for >1year. Urinary cortisol was measured in 24h urine, using LC-MS/MS (LOQ 0.30nmol/L). We
included 563 RTR (age 51+/-12years; 54% male) at median 6.0 [IQR, 2.6-11.5] years post-transplantation.
MS was present in 439/563 RTR (78%). Median 24h urinary cortisol excretion was 2.0 [IQR, 0.9-
5.1]nmol/24h. Twenty-four hour urinary cortisol excretion was independently associated with MS presence
(OR=0.80 [95% CI, 0.66-0.98], P=0.02). It was also independently associated with bodyweight (st.beta=-
0.11, P=0.007), waist circumference (st.beta=-0.10, P=0.01), BMI (st.beta=-0.14, P=0.001), fasting
triglycerides (st.beta=-0.15, P=0.001), diabetes (st.beta=-0.12, P=0.005), and number of antihypertensives
used (st.beta=-0.13, P=0.003). Suppressed HPA-axis activity, as reflected by decreased 24h urinary cortisol
excretion, is associated with higher prevalence of MS and its individual components (i.e. central obesity,
dyslipidemia, diabetes, hypertension) in prednisolone-treated RTR. Assessment of 24h urinary cortisol
excretion by LC-MS/MS may be a tool to monitor metabolic side-effects of prednisolone in RTR.
Copyright © 2017 Elsevier Inc. All rights reserved.
Registry Number/Name of Substance
9PHQ9Y1OLM (Prednisolone). WI4X0X7BPJ (Hydrocortisone).
Publication Type
Journal Article. Research Support, Non-U.S. Gov't.
Year of Publication
2017
Link to the Ovid Full Text or citation:

Click here for full text options
<102>
Unique Identifier
28577736
Title
[Post-transplantation diabetes mellitus in kidney recipients]. [French]
Original Title
Diabetes post-transplantation renale.
Source
Nephrologie et Therapeutique. 13 Suppl 1:S137-S146, 2017 Apr.
VI 1
Record Owner
Page 2
Status
MEDLINE
Authors
Dubois-Laforgue D.
Authors Full Name
Dubois-Laforgue, Daniele.
Institution
Dubois-Laforgue, Daniele. Service de diabetologie, hopital Cochin-Port Royal, 123, boulevard Port-
Royal, 75014 Paris, France; Inserm U1016, institut Cochin, 22, rue Mechain, 75014 Paris, France.
Electronic address: daniele.dubois@aphp.fr.
Body Mass Index
*Diabetes Mellitus/ci [Chemically Induced]
Diabetes Mellitus/ep [Epidemiology]
Diabetes Mellitus, Type 2/ci [Chemically Induced]
France/ep [Epidemiology]
Humans
*Immunosuppressive Agents/ae [Adverse Effects]
Incidence
*Kidney Transplantation/ae [Adverse Effects]
Obesity/co [Complications]
Prognosis
Keyword Heading
Diabetes mellitus
Diabete
Immunosuppressant
Immunosuppresseurs
Insulin resistance
Insulin secretion
Insulinoresistance
Insulinosecretion
Kidney transplantation
Transplantation renale
Abstract
Post-transplantation diabetes mellitus is defined as diabetes that is diagnosed in grafted patients. It affects
20 to 30 % of kidney transplant recipients, with a high incidence in the first year. The increasing age at
transplantation and the rising incidence of obesity may increase its prevalence in the next years. Post-
transplantation diabetes mellitus is associated with poor outcomes, such as mortality, cardiovascular events
or graft dysfunction. Its occurrence is mainly related to immunosuppressive agents, affecting both insulin
secretion and sensibility. Immunosuppressants may be iatrogenic, and as such, induce an early and transient
diabetes. They may also precociously determine a permanent diabetes, acting here as a promoting factor in
patients proned to the development of type 2 diabetes. Lastly, they may behave, far from transplantation, as
an additional risk factor for type 2 diabetes. The screening, management and prognosis of these different
subtypes of post-transplantation diabetes mellitus will be different. Copyright © 2017 Societe francophone
de nephrologie, dialyse et transplantation. Published by Elsevier Masson SAS. All rights reserved.
0 (Immunosuppressive Agents).
Publication Type
Journal Article.
Year of Publication
2017

Page 3
<103>
Unique Identifier
28538426
Title
Managing kidney transplant recipients in primary care. [Review]
Source
JAAPA. 30(6):26-33, 2017 Jun.
VI 1
Record Owner
Status
MEDLINE
Authors
Roth S.
Authors Full Name
Roth, Shira.
Institution
Roth, Shira. Shira Roth practices general nephrology at Stanford University Hospital in Stanford, Calif.,
after completing a fellowship in abdominal organ transplant at Mayo Clinic in Phoenix, Ariz. The author
has disclosed no potential conflicts of interest, financial or otherwise.
Anemia/et [Etiology]
Diabetes Mellitus, Type 2/et [Etiology]
Gout/et [Etiology]
Graft Rejection/di [Diagnosis]
Graft Rejection/et [Etiology]
Heart Diseases/et [Etiology]
Humans
Infection/et [Etiology]
Metabolic Syndrome/et [Etiology]
*Neoplasms/et [Etiology]
Obesity/et [Etiology]
Osteoporosis/et [Etiology]
*Postoperative Complications/et [Etiology]
Postoperative Period
Practice Guidelines as Topic
*Primary Health Care
*Transplant Recipients
Abstract
Patients who have undergone kidney transplant are at increased risk for heart disease, new-onset diabetes,
metabolic syndrome, and certain malignancies, in addition to opportunistic infections associated with
immunosuppression. This article describes guidelines for routine management of kidney transplant
recipients in primary care, as well as how to recognize risk factors and complications.
Publication Type
Journal Article. Review.
Year of Publication
2017

Page 4
<104>
Unique Identifier
28457383
Title
Kidney Transplantation in Alstrom Syndrome: Case Report.
Source
Transplantation Proceedings. 49(4):733-735, 2017 May.
VI 1
Record Owner
Status
MEDLINE
Authors
Poli L; Arroyo G; Garofalo M; Choppin de Janvry E; Intini G; Saracino A; Pretagostini R; Della Pietra F;
Berloco PB.
Authors Full Name
Poli, L; Arroyo, G; Garofalo, M; Choppin de Janvry, E; Intini, G; Saracino, A; Pretagostini, R; Della
Pietra, F; Berloco, P B.
Institution
Poli, L. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma, Policlinico
Umberto I, Rome, Italy. Electronic address: luca.poli@uniroma1.it.
Arroyo, G. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma, Policlinico
Umberto I, Rome, Italy.
Garofalo, M. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma, Policlinico
Choppin de Janvry, E. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma,
Policlinico Umberto I, Rome, Italy.
Intini, G. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma, Policlinico
Saracino, A. UOC Nefrologia, Coordinamento Regionale Trapianti Basilicata, Ospedale Madonna delle
Grazie, Matera, Italy.
Pretagostini, R. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma,
Della Pietra, F. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma,
Berloco, P B. UOC Chirurgia Generale e Trapianti d'Organo, La Sapienza Universita di Roma,
Adult
*Alstrom Syndrome/co [Complications]
Humans
*Kidney Failure, Chronic/et [Etiology]
*Kidney Failure, Chronic/su [Surgery]
Male
Abstract
The Alstrom syndrome is a rare genetic disorder, inherited in an autosomal recessive manner. It has
recently been classified as a ciliopathic disorder. Alstrom syndrome is a multiorgan pathology
characterized by cone-rod dystrophy, hearing loss, childhood truncal obesity, insulin resistance and
hyperinsulinemia, type 2 diabetes mellitus, dyslipidemia, short stature in adulthood, hypothyroidism,
hypogonadism, dilated or restrictive cardiomyopathy, and progressive pulmonary, hepatic, and renal
dysfunction. End-stage renal disease can occur as early as the late teens and is the leading cause of death.
More than 900 people with Alstrom syndrome have been reported worldwide. We present a case of a 42-
year-old man affected by this syndrome with end-stage renal disease, type 2 diabetes mellitus, and loss of
Page 5
visual function and hearing who received a kidney transplant from a cadaveric donor. Basiliximab and
steroid were used as induction therapy. Tacrolimus, mycophenolate mofetil, and steroid were used as
maintenance therapy. No complications were reported during the recovery. In selected patients affected by
Alstrom syndrome, renal transplantation can be a successful treatment for chronic kidney disease.
Publication Type
Case Reports. Journal Article.
Year of Publication
2017

<105>
Unique Identifier
28432716
Title
Deciphering Tacrolimus-Induced Toxicity in Pancreatic beta Cells.
Source
American Journal of Transplantation. 17(11):2829-2840, 2017 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Trinanes J; Rodriguez-Rodriguez AE; Brito-Casillas Y; Wagner A; De Vries APJ; Cuesto G; Acebes A;
Salido E; Torres A; Porrini E.
Authors Full Name
Trinanes, J; Rodriguez-Rodriguez, A E; Brito-Casillas, Y; Wagner, A; De Vries, A P J; Cuesto, G;
Acebes, A; Salido, E; Torres, A; Porrini, E.
Institution
Trinanes, J. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
La Laguna, Tenerife, Spain.
Trinanes, J. Division of Nephrology and Leiden Transplant Center, Leiden University Medical Center
and Leiden University, Leiden, the Netherlands.
Rodriguez-Rodriguez, A E. Research Unit of the University Hospital of the Canary Islands, La Laguna,
Tenerife, Spain.
Brito-Casillas, Y. Unit of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular
Materno-Infantil de Gran Canaria, Instituto Universitario de Investigaciones Biomedicas y Sanitarias,
University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Wagner, A. Unit of Endocrinology and Nutrition, Complejo Hospitalario Universitario Insular Materno-
Infantil de Gran Canaria, Instituto Universitario de Investigaciones Biomedicas y Sanitarias, University of
Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
De Vries, A P J. Division of Nephrology and Leiden Transplant Center, Leiden University Medical
Center and Leiden University, Leiden, the Netherlands.
Cuesto, G. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
Acebes, A. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
Salido, E. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
Salido, E. Pathology Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
Page 6
Salido, E. Centre for Biomedical Research on Rare Diseases (CIBERER), La Laguna, Tenerife, Spain.
Torres, A. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
Torres, A. Research Unit of the University Hospital of the Canary Islands, La Laguna, Tenerife, Spain.
Torres, A. Nephrology Department, Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.
Porrini, E. Centre for Biomedical Research of the Canary Islands (CIBICAN), University of La Laguna,
Animals
Calcineurin/pd [Pharmacology]
Cyclosporine/pd [Pharmacology]
*Diabetes Mellitus, Experimental/dt [Drug Therapy]
Diabetes Mellitus, Experimental/me [Metabolism]
Diabetes Mellitus, Experimental/pa [Pathology]
*Diabetes Mellitus, Type 2/dt [Drug Therapy]
Diabetes Mellitus, Type 2/me [Metabolism]
Diabetes Mellitus, Type 2/pa [Pathology]
Glucose/me [Metabolism]
*Immunosuppressive Agents/pd [Pharmacology]
Insulin/me [Metabolism]
Insulin Resistance
*Insulin-Secreting Cells/de [Drug Effects]
Insulin-Secreting Cells/me [Metabolism]
Insulin-Secreting Cells/pa [Pathology]
NFATC Transcription Factors/me [Metabolism]
Nerve Tissue Proteins/me [Metabolism]
Obesity/pp [Physiopathology]
Rats
Rats, Zucker
*Tacrolimus/pd [Pharmacology]
Thinness/pp [Physiopathology]
Keyword Heading
animal models
basic (laboratory) research/science
calcineurin inhibitor (CNI)
cellular biology
clinical research/practice
diabetes: new onset/posttransplant
drug toxicity
immunosuppressant
islets of Langerhans
kidney transplantation/nephrology
molecular biology
Abstract
beta Cell transcription factors such as forkhead box protein O1 (FoxO1), v-maf musculoaponeurotic
fibrosarcoma oncogene homolog A (MafA), pancreatic and duodenal homeobox 1, and neuronal
differentiation 1, are dysfunctional in type 2 diabetes mellitus (T2DM). Posttransplant diabetes mellitus
resembles T2DM and reflects interaction between pretransplant insulin resistance and immunosuppressants,
mainly calcineurin inhibitors (CNIs). We evaluated the effect of tacrolimus (TAC), cyclosporine A (CsA),
and metabolic stressors (glucose plus palmitate) on insulinoma beta cells in vitro and in pancreata of obese
and lean Zucker rats. Cells were cultured for 5 days with 100 muM palmitate and 22 mM glucose; CsA
(250 ng/mL) or TAC (15 ng/mL) were added in the last 48 h. Glucose plus palmitate increased nuclear
FoxO1 and decreased nuclear MafA. TAC in addition to glucose plus palmitate magnified these changes in
nuclear factors, whereas CsA did not. In addition to glucose plus palmitate, both drugs reduced insulin
content, and TAC also affected insulin secretion. TAC withdrawal or conversion to CsA restored these
changes. Similar results were observed in pancreata of obese animals on CNIs. TAC and CsA, in addition
Page 7
to glucose plus palmitate, induced comparable inhibition of calcineurin and nuclear factor of activated T
cells (NFAT); therefore, TAC potentiates glucolipotoxicity in beta cells, possibly by sharing common
pathways of beta cell dysfunction. TAC-induced beta cell dysfunction is potentially reversible. Inhibition of
the calcineurin-NFAT pathway may contribute to the diabetogenic effect of CNIs but does not explain the
stronger effect of TAC compared with CsA. Copyright © 2017 The American Society of Transplantation
and the American Society of Transplant Surgeons.
0 (Immunosuppressive Agents). 0 (Insulin). 0 (NFATC Transcription Factors). 0 (Nerve Tissue Proteins).
147604-79-3 (Foxo1 protein, rat). 83HN0GTJ6D (Cyclosporine). EC 3-1-3-16 (Calcineurin).
IY9XDZ35W2 (Glucose). WM0HAQ4WNM (Tacrolimus).
Publication Type
Journal Article.
Year of Publication
2017

<106>
Unique Identifier
28000288
Title
The impact of kidney transplantation on insulin sensitivity.
Source
Transplant International. 30(3):295-304, 2017 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Jorgensen MB; Hornum M; van Hall G; Bistrup C; Hansen JM; Mathiesen ER; Feldt-Rasmussen B.
Author NameID
Jorgensen, Morten B; ORCID: http://orcid.org/0000-0001-9681-3134
Authors Full Name
Jorgensen, Morten B; Hornum, Mads; van Hall, Gerrit; Bistrup, Claus; Hansen, Jesper M; Mathiesen,
Elisabeth R; Feldt-Rasmussen, Bo.
Institution
Jorgensen, Morten B. Department of Nephrology, Rigshospitalet, University of Copenhagen,
Copenhagen, Denmark.
Hornum, Mads. Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark.
van Hall, Gerrit. Clinical Metabolomics Core Facility, Clinical Biochemistry, Rigshospitalet, University
of Copenhagen, Copenhagen, Denmark.
Bistrup, Claus. Department of Nephrology, Odense University Hospital, Odense, Denmark.
Hansen, Jesper M. Department of Nephrology, Herlev Hospital, University of Copenhagen, Copenhagen,
Denmark.
Mathiesen, Elisabeth R. Department of Endocrinology, Rigshospitalet, University of Copenhagen,
Feldt-Rasmussen, Bo. Department of Nephrology, Rigshospitalet, University of Copenhagen,
Comments
Comment in (CIN)
Page 8
Comment in (CIN)
Adult
Blood Glucose/me [Metabolism]
Body Composition
Case-Control Studies
Female
Glucagon/bl [Blood]
Glucose/bi [Biosynthesis]
Glucose Clamp Technique
Glucose Tolerance Test
Humans
Insulin/bl [Blood]
*Insulin Resistance/ph [Physiology]
Lipolysis/ph [Physiology]
Living Donors
Male
Middle Aged
Time Factors
Young Adult
Keyword Heading
hyperinsulinaemic-euglycaemic clamp
insulin resistance
kidney transplantation
Abstract
To investigate the impact of kidney transplantation (KTx) on insulin sensitivity affecting glucose
metabolism. 9 nondiabetic patients awaiting living donor KTx were examined prior to transplantation with
an oral glucose tolerance test and a 3-h hyperinsulinaemic-euglycaemic clamp. The clamp was repeated 6
months after KTx. Nine age-, gender- and body mass index (BMI)-matched individuals with normal kidney
function served as controls. Endogenous glucose production and glucose disappearance rate (N = 6) were
measured in a subgroup of patients with corresponding controls. Results presented as mean [range]. Two
patients had pretransplant prediabetes, whereas all others had normal glucose tolerance. After KTx, average
glucose infusion rate to maintain euglycaemia during clamp declined significantly from 15.1 [9.1-23.7] to
9.8 [2.8-14.6] mumol/kg/min (P < 0.01) with 20.2 [9.9-33.7] mumol/kg/min in controls. Endogenous
glucose production increased from 7.0 [4.8-8.5] to 9.4 [7.4-11.8] mumol/kg/min (P < 0.05) with 7.0 [-3.8 to
10.1] mumol/kg/min in controls. Glucose disappearance rate was unchanged (18.1 [12.9-24.5] vs. 17.1
[12.2-22.7] mumol/kg/min, NS) with 22.3 [14.6-34.3] in controls. In conclusion, insulin sensitivity is
reduced 6 months after KTx and characterized mainly by impaired suppression of the endogenous glucose
production. Copyright © 2016 Steunstichting ESOT.
0 (Blood Glucose). 0 (Insulin). 9007-92-5 (Glucagon). IY9XDZ35W2 (Glucose).
Publication Type
Journal Article.
Year of Publication
2017

<107>
Unique Identifier
27859633
Page 9
Title
Visceral fat is strongly associated with post-transplant diabetes mellitus and glucose metabolism 1 year
after kidney transplantation.
Source
Clinical Transplantation. 31(1), 2017 01.
VI 1
Record Owner
Status
MEDLINE
Authors
von During ME; Jenssen T; Bollerslev J; Asberg A; Godang K; Hartmann A.
Authors Full Name
von During, Marit Elizabeth; Jenssen, Trond; Bollerslev, Jens; Asberg, Anders; Godang, Kristin;
Hartmann, Anders.
Institution
von During, Marit Elizabeth. Section of Nephrology, Department of Transplantation Medicine, Oslo
University Hospital, Rikshospitalet, Oslo, Norway.
von During, Marit Elizabeth. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo,
Oslo, Norway.
Jenssen, Trond. Section of Nephrology, Department of Transplantation Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway.
Jenssen, Trond. Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromso,
Norway.
Bollerslev, Jens. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Bollerslev, Jens. Section of Specialized Endocrinology, Department of Endocrinology, Oslo University
Asberg, Anders. Section of Nephrology, Department of Transplantation Medicine, Oslo University
Asberg, Anders. Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Asberg, Anders. School of Pharmacy, University of Oslo, Oslo, Norway.
Godang, Kristin. Section of Specialized Endocrinology, Department of Endocrinology, Oslo University
Hartmann, Anders. Section of Nephrology, Department of Transplantation Medicine, Oslo University
Hartmann, Anders. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo,
Norway.
Adult
Aged
Biomarkers/me [Metabolism]
*Blood Glucose/me [Metabolism]
Body Composition
Body Mass Index
*Diabetes Mellitus/et [Etiology]
Diabetes Mellitus/me [Metabolism]
Diabetes Mellitus/pa [Pathology]
Female
Follow-Up Studies
Glomerular Filtration Rate
Graft Survival
Humans
Insulin/bl [Blood]
*Insulin Resistance
*Intra-Abdominal Fat/pp [Physiopathology]
Page 10
Kidney Failure, Chronic/su [Surgery]
Kidney Function Tests
Male
Middle Aged
Prognosis
Risk Factors
Keyword Heading
*body composition
*insulin resistance
*kidney transplantation
*post-transplant diabetes mellitus
*visceral fat
Abstract
Body composition after kidney transplantation is linked to glucose metabolism, and impaired glucose
metabolism is associated with increased risk of cardiovascular events and death. One year after
transplantation, we examined 150 patients for post-transplant diabetes performing oral glucose tolerance
tests and body composition measurements including visceral adipose tissue (VAT) content from dual-
energy X-ray absorptiometry scans. We found that glucose metabolism was generally improved over the
first year post-transplant, and that the levels of VAT and percentage VAT of total body fat mass (VAT
%totBFM ) were lowest in those with normal glucose tolerance and highest in those with post-transplant
diabetes mellitus. In a multivariable linear regression analysis, 87.4% of the variability in fasting glucose
concentration was explained by insulin resistance (P<.001, HOMA-IR index), beta cell function (P<.001,
HOMA-beta), VAT%totBFM (P=.007), and body mass index (BMI; P=.015; total model P<.001), while
insulin resistance (P<.001) and beta cell function (P<.001) explained 31.9% of the variability in 2-hour
glucose concentration in a multivariable model (total model P<.001). VAT was associated with glucose
metabolism to a larger degree than BMI. In conclusion, VAT is associated with hyperglycemia one year
after kidney transplantation, and insulin resistance and beta cell function estimates are the most robust
markers of glucose metabolism. Copyright © 2016 John Wiley & Sons A/S. Published by John Wiley &
Sons Ltd.
0 (Biomarkers). 0 (Blood Glucose). 0 (Insulin).
Publication Type
Year of Publication
2017

<108>
Unique Identifier
27505857
Title
Impact of renal transplantation on glucose tolerance in Japanese recipients with impaired glucose
tolerance.
Source
Diabetic Medicine. 34(4):569-576, 2017 04.
VI 1
Record Owner
Status
Page 11
MEDLINE
Authors
Nakamura A; Iwami D; Miyoshi H; Morita K; Taguri M; Terauchi Y; Shinohara N; Atsumi T.
Authors Full Name
Nakamura, A; Iwami, D; Miyoshi, H; Morita, K; Taguri, M; Terauchi, Y; Shinohara, N; Atsumi, T.
Institution
Nakamura, A. Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate
School of Medicine, Sapporo.
Iwami, D. Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of
Medicine, Sapporo.
Miyoshi, H. Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate
Morita, K. Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of
Medicine, Sapporo.
Taguri, M. Department of Biostatistics, Yokohama City University, Yokohama.
Terauchi, Y. Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama
City University, Yokohama, Japan.
Shinohara, N. Department of Renal and Genitourinary Surgery, Hokkaido University Graduate School of
Medicine, Sapporo.
Atsumi, T. Division of Rheumatology, Endocrinology and Nephrology, Hokkaido University Graduate
Adult
Comorbidity
Diabetes Mellitus, Type 2/ep [Epidemiology]
Disease Progression
Female
Glucose Intolerance/ep [Epidemiology]
*Glucose Intolerance/me [Metabolism]
Humans
Insulin Resistance
Japan/ep [Epidemiology]
Kidney Failure, Chronic/ep [Epidemiology]
Male
Middle Aged
Remission Induction
Treatment Outcome
Abstract
AIMS: To investigate changes in glucose tolerance, insulin secretion and insulin sensitivity in Japanese
recipients before and 1 year after renal transplantation.
METHODS: We conducted a study of Japanese recipients without diabetes who underwent renal
transplantation at Hokkaido University Hospital. A 75-g oral glucose tolerance test was performed before
and 1 year after renal transplantation in these recipients. Insulin sensitivity was estimated using the
Matsuda index and homeostasis model assessment of insulin resistance (HOMA-IR). Insulin secretion was
evaluated based on the insulin secretion sensitivity index-2 (ISSI-2).
RESULTS: Of the 62 renal transplant recipients, 31 were diagnosed as having impaired glucose tolerance
before transplantation. Among these 31 recipients, after 1 year, four had developed new-onset diabetes after
transplantation, and nine had impaired glucose tolerance. Unexpectedly, 18 changed from impaired to
normal glucose tolerance. When these recipients with impaired glucose tolerance were classified into a
non-amelioration group and an amelioration group, the ISSI-2 was significantly reduced, with no
significant changes in the Matsuda index or HOMA-IR, in the non-amelioration group 1 year after renal
Page 12
transplantation. By contrast, ISSI-2 and Matsuda index values were significantly increased, with no
significant changes in HOMA-IR values in the amelioration group.
CONCLUSIONS: More than half of Japanese renal transplant recipients with impaired glucose tolerance
had normal glucose tolerance 1 year after renal transplantation. These results suggest that an increase in
insulin secretion and whole insulin sensitivity was associated with improvement in glucose tolerance in
these recipients. Copyright © 2016 Diabetes UK.
Publication Type
Journal Article.
Year of Publication
2017

<109>
Unique Identifier
27381969
Title
Metabolic syndrome and new onset diabetes after kidney transplantation.
Source
Diabetes & Metabolic Syndrome. 11(3):211-214, 2017 Jul - Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Dedinska I; Palkoci B; Miklusica J; Osinova D; Galajda P; Mokan M.
Authors Full Name
Dedinska, I; Palkoci, B; Miklusica, J; Osinova, D; Galajda, P; Mokan, M.
Institution
Dedinska, I. Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius
Medical Faculty of the Comenius University. Electronic address: idedinska@yahoo.co.uk.
Palkoci, B. Department of Surgery and Transplantation Center, University Hospital Martin and Jessenius
Medical Faculty of the Comenius University.
Miklusica, J. Department of Surgery and Transplantation Center, University Hospital Martin and
Jessenius Medical Faculty of the Comenius University.
Osinova, D. Department of Anaesthetics and Intensive Medicine, University Hospital Martin and
Jessenius Medical Faculty of the Comenius University.
Galajda, P. I. Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty
of the Comenius University.
Mokan, M. I. Department of Internal Diseases, University Hospital Martin and Jessenius Medical Faculty
of the Comenius University.
Adult
Cholesterol, HDL/bl [Blood]
Diabetes Mellitus/di [Diagnosis]
*Diabetes Mellitus/ep [Epidemiology]
Female
Humans
Page 13
Hyperglycemia/di [Diagnosis]
Hyperglycemia/ep [Epidemiology]
Hyperglycemia/me [Metabolism]
Kidney Transplantation/ae [Adverse Effects]
*Kidney Transplantation/td [Trends]
Male
Metabolic Syndrome/di [Diagnosis]
*Metabolic Syndrome/ep [Epidemiology]
Metabolic Syndrome/me [Metabolism]
Middle Aged
Postoperative Complications/di [Diagnosis]
*Postoperative Complications/ep [Epidemiology]
Postoperative Complications/me [Metabolism]
Risk Factors
Waist Circumference/ph [Physiology]
Keyword Heading
Immunosuppressive therapy
Metabolic syndrome
Abstract
AIMS: The metabolic syndrome developed after kidney transplantation is the result of several factors
which are identical with the risk factors in normal population, however, also some factors typical for the
transplanted patients-especially the effects of immunosuppressive therapy.
MATERIAL AND METHODS: In the groupof 268 patients after kidney transplantation, which had no
type 1 or type 2 diabetes mellitus before transplantation, we identified patients with metabolic
syndrome(based on IDF criteria), 12 months from the kidney transplantation. In all patients, we recorded
the following parameters: age at the time of transplantation, type of immunosuppression, waist measure, the
value of triacylglycerols, the value of HDL cholesterol, presence of arterial hypertension, andthe value of
glycaemia in fasting state (or presence of diabetes mellitus). The groupof patients was divided into the
control group and the group of patients with metabolic syndrome.
RESULTS: The average age of patients was 46.1+/-11.6years. The control group included 149 patients
(55.6%),and we identified the metabolicsyndromein 119patients (44.4%). The patients with
metabolicsyndrome were significantly older (P<0.0001), had significantly larger waist (both the
entiregroup and the males andfemales) P<0.0001.The femaleswith metabolic syndrome had significantly
lower value of HDL-cholesterol (P=0.0013), and significantly higher number of patients with metabolic
syndrome had hyperglycaemia in fasting state or diabetes mellitus (P=0.0006).
CONCLUSION: By controlling the weight and waist, we may identify the risk patients for development
of metabolic syndrome after kidney transplantation. Copyright © 2016 Diabetes India. Published by
Elsevier Ltd. All rights reserved.
0 (Blood Glucose). 0 (Cholesterol, HDL).
Publication Type
Journal Article.
Year of Publication
2017

<110>
Page 14
Unique Identifier
28740594
Title
Opportunities for treatment of the hepatitis C virus-infected patient with chronic kidney disease. [Review]
Source
World Journal of Hepatology. 9(19):833-839, 2017 Jul 08.
VI 1
Record Owner
Status
PubMed-not-MEDLINE
Authors
Ladino M; Pedraza F; Roth D.
Authors Full Name
Ladino, Marco; Pedraza, Fernando; Roth, David.
Institution
Ladino, Marco. Marco Ladino, Fernando Pedraza, Miller School of Medicine and the Miami Veterans
Administration Medical Center, Miami, FL 33136, United States.
Pedraza, Fernando. Marco Ladino, Fernando Pedraza, Miller School of Medicine and the Miami Veterans
Roth, David. Marco Ladino, Fernando Pedraza, Miller School of Medicine and the Miami Veterans
Keyword Heading
Chronic kidney disease
Direct acting antiviral agents
Hepatitis C virus
Abstract
The prevalence of hepatitis C virus (HCV) infection amongst patients with chronic kidney disease (CKD)
and end-stage renal disease exceeds that of the general population. In addition to predisposing to the
development of cirrhosis and hepatocellular carcinoma, infection with HCV has been associated with extra-
hepatic complications including CKD, proteinuria, glomerulonephritis, cryoglobulinemia, increased
cardiovascular risk, insulin resistance, and lymphoma. With these associated morbidities, infection with
HCV is not unexpectedly accompanied by an increase in mortality in the general population as well as in
patients with kidney disease. Advances in the understanding of the HCV genome have resulted in the
development of direct-acting antiviral agents that can achieve much higher sustained virologic response
rates than previous interferon-based protocols. The direct acting antivirals have either primarily hepatic or
renal metabolism and excretion pathways. This information is particularly relevant when considering
treatment in patients with reduced kidney function. In this context, some of these agents are not
recommended for use in patients with a glomerular filtration rate < 30 mL/min per 1.73 m2. There are now
Food and Drug Administration approved direct acting antiviral agents for the treatment of patients with
kidney disease and reduced function. These agents have been demonstrated to be effective with sustained
viral response rates comparable to the general population with good safety profiles. A disease that was only
recently considered to be very challenging to treat in patients with kidney dysfunction is now curable with
these medications.
Publication Type
Year of Publication
2017

Page 15
<111>
Unique Identifier
27931571
Title
Incidence of Diabetes Mellitus After Kidney Transplantation in Slovakia: Multicentric, Prospective
Analysis.
Source
Transplantation Proceedings. 48(10):3292-3298, 2016 12.
VI 1
Record Owner
Status
MEDLINE
Authors
Dedinska I; Baltesova T; Bena L; Cellar M; Galajda P; Chrastina M; Jurcina A; Kovacikova L; Laca L;
Lackova E; Laukova Valachova S; Miklusica J; Rosenberger J; Sersenova M; Skalova P; Zilinska Z;
Mokan M.
Authors Full Name
Dedinska, I; Baltesova, T; Bena, L; Cellar, M; Galajda, P; Chrastina, M; Jurcina, A; Kovacikova, L; Laca,
L; Lackova, E; Laukova Valachova, S; Miklusica, J; Rosenberger, J; Sersenova, M; Skalova, P; Zilinska,
Z; Mokan, M.
Institution
Dedinska, I. Surgery Clinic and Transplantation Center, University Hospital in Martin and Jessenius
Medical Faculty of the Comenius University, Martin, Slovak Republic.
Baltesova, T. Transplant Department, L. Pasteur's University Hospital, Kosice, Slovak Republic.
Bena, L. Transplant Department, L. Pasteur's University Hospital, Kosice, Slovak Republic.
Cellar, M. Department of Transplant Nephrology, II. Internal Clinic of Slovak Medical University, F.D.
Roosevelt's Faculty Hospital, Banska Bystrica, Slovak Republic.
Galajda, P. I. Internal Clinic, University Hospital Martin and Jessenius Medical Faculty of the Comenius
University, Martin, Slovak Republic.
Chrastina, M. Department of Urology and Renal Transplantation Center, University Hospital Bratislava
and Medical Faculty of the Comenius University, Bratislava, Slovak Republic.
Jurcina, A. Transplant Department, L. Pasteur's University Hospital, Kosice, Slovak Republic.
Kovacikova, L. Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic.
Laca, L. Surgery Clinic and Transplantation Center, University Hospital in Martin and Jessenius Medical
Faculty of the Comenius University, Martin, Slovak Republic.
Lackova, E. Transplant Department, L. Pasteur's University Hospital, Kosice, Slovak Republic.
Laukova Valachova, S. Surgery Clinic and Transplantation Center, University Hospital in Martin and
Jessenius Medical Faculty of the Comenius University, Martin, Slovak Republic.
Miklusica, J. Surgery Clinic and Transplantation Center, University Hospital in Martin and Jessenius
Medical Faculty of the Comenius University, Martin, Slovak Republic. Electronic address:
juraj.miklusica@gmail.com.
Rosenberger, J. Transplant Department, L. Pasteur's University Hospital, Kosice, Slovak Republic.
Sersenova, M. Department of Urology and Renal Transplantation Center, University Hospital Bratislava
and Medical Faculty of the Comenius University, Bratislava, Slovak Republic.
Skalova, P. Surgery Clinic and Transplantation Center, University Hospital in Martin and Jessenius
Medical Faculty of the Comenius University, Martin, Slovak Republic.
Zilinska, Z. Department of Urology and Renal Transplantation Center, University Hospital Bratislava and
Medical Faculty of the Comenius University, Bratislava, Slovak Republic.
Mokan, M. I. Internal Clinic, University Hospital Martin and Jessenius Medical Faculty of the Comenius
University, Martin, Slovak Republic.
Comments
Erratum in (EIN)
Adult
Age Factors
Page 16
Body Mass Index
Female
Humans
Incidence
*Insulin Resistance
Logistic Models
Male
Middle Aged
Odds Ratio
Postoperative Complications/ep [Epidemiology]
Prospective Studies
Risk Factors
Slovakia
Abstract
BACKGROUND: The incidence rate of post-transplant diabetes mellitus (PTDM) after kidney
transplantation (KT) is 5% to 40%. The objective of this analysis was to identify the risk factors of PTDM
after KT in the Slovak Republic (SR).
METHODS: In the group of 133 patients/non-diabetics, we identified the risk factors of PTDM in the
monitored period of 12 months from transplantation.
RESULTS: The incidence of PTDM in the SR in 2014 was 38.3%. By logistic regression, we discovered
that the age at the time of KT [odds ratio, 1.0885; 95% CI, 1.0222-1.1592; P = .0082], the value of body
mass index (BMI) at the time of KT [odds ratio, 1.4606; 95% CI, 1.0099-2.1125; P = .0442], and the value
of insulin resistance index (homeostatic model assessment for insulin resistance) at the time of KT [odds
ratio, 2.5183; 95% CI, 1.7119-3.4692; P < .0001] represented predictive factors of PTDM. The independent
risk factors of PTDM in our group were age at the time of KT of more than 60 years [HR 0.3871; 95% CI
0.1659-1.7767; P = .0281], waist circumference at the time of KT in men more than 94 cm and in women
more than 80 cm [HR, 3.4833; 95% CI, 1.2789-9.4878 (P = .0146)], BMI at the time of KT [HR 3.0011;
95% CI 1.0725-8.3977 (P = .0363)], and triacylglycerols at the time of KT more than 1.7 mmol/L [HR,
2.9763; 95% CI, 1.0141-8.7352; P = .0471].
CONCLUSIONS: In the group of Slovak patients after kidney transplantation, the dominating risk factor
for PTDM development was insulin resistance prior to KT. Copyright © 2016 Elsevier Inc. All rights
reserved.
Publication Type
Journal Article.
Year of Publication
2016

<112>
Unique Identifier
27642745
Title
[Posttransplantation diabetes mellitus in patients after kidney transplantation - Incidence and risk factors].
[German]
Page 17
Original Title
Posttransplantationsdiabetes mellitus bei Patienten nach Nierentransplantation.
Source
Deutsche Medizinische Wochenschrift. 141(19):e173-82, 2016 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Jahn I; Busch M; Ott U; Wolf G; Battefeld W.
Authors Full Name
Jahn, Isabell; Busch, Martin; Ott, Undine; Wolf, Gunter; Battefeld, Wilgard.
Aged
Blood Glucose
Humans
Incidence
Middle Aged
Prospective Studies
Risk Factors
Abstract
BACKGROUND: Transplantation (NTX) associated ischemia-reperfusion-mechanisms and the
predisposition for insulin resistance are discussed as causes of a posttransplantation diabetes mellitus
(PTDM). Furthermore, immunosuppressants can have a damaging effect on insulin secretion.
METHODS: 55 metabolically healthy patients with an endstage renal disease (age 52 +/- 14 years, body
mass index 27 +/- 5 kg / m(2), blood pressure 137 +/- 15/82 +/- 11 mmHg) were included in a
prospectively cohort study. These patients were transplanted between 2009 and 2011 (82 % of the NTX
patients). Baseline examination was performed before NTX. Within the 2nd week as well as 6 and 12
months after transplantation an oral glucose tolerance test (oGGT), 3 and 9 months after NTX a glucagon
test took place. In these connections the determination of plasma glucose, C-peptide and insulin was
performed. Study endpoints were: graft failure, impaired glucose tolerance (iGT), PTDM, patient's death.
RESULTS: Over a follow-up-period of 1 year post NTX iGT / PTDM occurred in 31 % and graft failure
in 13 %. In comparison with the healthy control group patients with iGT / PTDM were older (59 +/- 8 vs.
48 +/- 14ys, p = 0.001), overweight (BMI 29 +/- 4 vs. 26 +/- 5 kg / m(2), p = 0.038), showed an indication
of an insulin resistance before NTX (HOMA 4.0 +/- 2.9 vs. 2.4 +/- 1.4, p = 0.013; C-peptide 10.1 +/- 5.2
vs. 7.1 +/- 3.6 ng / ml, p = 0.014; insulin 14.6 +/- 9.4 vs. 10.6 +/- 5.5mU / l, p = 0.045) and higher HbA1c
levels (5.6 +/- 0.5 vs. 5.4 +/- 0.4 %, p = 0.032). Age (p = 0.001), fasting plasma glucose (p = 0.042), the
glucose levels of oGTT immediately after transplantation were shown as prognostically relevant (fasting
glucose: p = 0.027; 1 h: p = 0.014; 2 h: p = 0.002). An isolated defective secretion as a result of a toxic
damage to the beta-cells by immunosuppressants couldn't be shown in any of the patients with iGT /
PTDM. 4 % of the patients died in the first year after NTX.
CONCLUSION: In 31 % a disorder of glucose metabolism was found as a frequent complication after

NTX. The HOMA index was found to be a meaningful marker for an existing insulin resistance. The
fasting glucose before and an oGTT in the first weeks after NTX showed itself as clinically valid laboratory
parameters for a risk assessment. Copyright © Georg Thieme Verlag KG Stuttgart . New York.
0 (Blood Glucose).
Page 18
Publication Type
Journal Article.
Year of Publication
2016

<113>
Unique Identifier
27550305
Title
Comparing glycaemic benefits of Active Versus passive lifestyle Intervention in kidney Allograft
Recipients (CAVIAR): study protocol for a randomised controlled trial.
Source
Trials [Electronic Resource]. 17:417, 2016 08 22.
VI 1
Record Owner
Status
MEDLINE
Authors
Wilcox J; Waite C; Tomlinson L; Driscoll J; Karim A; Day E; Sharif A.
Authors Full Name
Wilcox, Joanne; Waite, Chantelle; Tomlinson, Lyndsey; Driscoll, Joanne; Karim, Asra; Day, Edward;
Sharif, Adnan.
Institution
Wilcox, Joanne. Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham,
UK.
Waite, Chantelle. Department of Nephrology and Transplantation, Queen Elizabeth Hospital,
Birmingham, UK.
Tomlinson, Lyndsey. Department of Nutrition and Dietetics, Queen Elizabeth Hospital, Birmingham,
UK.
Driscoll, Joanne. Department of Nutrition and Dietetics, Queen Elizabeth Hospital, Birmingham, UK.
Karim, Asra. Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham,
UK.
Day, Edward. National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's
College London, London, UK.
Sharif, Adnan. Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Birmingham,
UK. adnan.sharif@uhb.nhs.uk.
Sharif, Adnan. School of Immunology and Inflammation, University of Birmingham, Birmingham, UK.
adnan.sharif@uhb.nhs.uk.
Allografts
*Behavior Therapy/mt [Methods]
Biomarkers/bl [Blood]
Clinical Protocols
England
Exercise Therapy
Glucose Intolerance/bl [Blood]
Glucose Intolerance/di [Diagnosis]
Glucose Intolerance/et [Etiology]
Page 19
*Glucose Intolerance/pc [Prevention & Control]
Glycated Hemoglobin A/me [Metabolism]
Health Behavior
Health Knowledge, Attitudes, Practice
Healthy Diet
Humans
Immunosuppressive Agents/ae [Adverse Effects]
Metabolic Syndrome/bl [Blood]
*Metabolic Syndrome/pc [Prevention & Control]
Nutritionists
Prospective Studies
Research Design
Risk Factors
*Risk Reduction Behavior
Time Factors
Treatment Outcome
Keyword Heading
*Active
*Behavioural therapy
*Cardiometabolic
*Glycaemic metabolism
*Kidney transplantation
*Lifestyle intervention
*Lifestyle modification
*Motivation
*New-onset diabetes after transplantation
*Passive
*Post-transplantation diabetes
*Weight gain
Abstract
BACKGROUND: Lifestyle modification is widely recommended to kidney allograft recipients post
transplantation due to the cardiometabolic risks associated with immunosuppression including new-onset
diabetes, weight gain and cardiovascular events. However, we have no actual evidence that undertaking
lifestyle modification protects from any adverse outcomes post transplantation. The aim of this study is to
compare whether a more proactive versus passive interventional approach to modify lifestyle is associated
with superior outcomes post kidney transplantation.
METHODS/DESIGN: We designed this prospective, single-centre, open-label, randomised controlled

study to compare the efficacy of active versus passive lifestyle intervention for kidney allograft recipients
early post transplantation. A total of 130 eligible patients, who are stable, nondiabetic and between 3 and
24 months post kidney transplantation, will be recruited. Randomisation is being undertaken by random
block permutations into passive (n = 65, leaflet guidance only) versus active lifestyle modification (n = 65,
supervised intervention) over a 6-month period. Supervised intervention is being facilitated by two
dietitians during the 6-month intervention period to provide continuous lifestyle intervention guidance,
support and encouragement. Both dietitians are accredited with behavioural intervention skills and will
utilise motivational aids to support study recruits randomised to active intervention. The primary outcome
is change in abnormal glucose metabolism parameters after 6 months of comparing active versus passive
lifestyle intervention. Secondary outcomes include changes in a wide array of cardiometabolic parameters,
kidney allograft function and patient-reported outcome measures. Long-term tracking of patients via data
linkage to electronic patient records and national registries will facilitate long-term comparison of
outcomes after active versus passive lifestyle intervention beyond the 6-month intervention period.
Page 20
DISCUSSION: This is the first randomised controlled study to investigate the benefits of active versus
passive lifestyle intervention in kidney allograft recipients for the prevention of abnormal cardiometabolic
outcomes. In addition, this is the first example of utilising behaviour therapy intervention post kidney
transplantation to achieve clinically beneficial outcomes, which has potential implications on many spheres
of post-transplant care.
TRIAL REGISTRATION: This study was registered with the Clinical Trials Registry on 27 August 2014
(ClinicalTrials.org Identifier: NCT02233491 ).
0 (Biomarkers). 0 (Blood Glucose). 0 (Glycated Hemoglobin A). 0 (Immunosuppressive Agents). 0
(hemoglobin A1c protein, human).
Publication Type
Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Year of Publication
2016

<114>
Unique Identifier
27491833
Title
ANGPTL2 is associated with an increased risk of cardiovascular events and death in diabetic patients.
Source
Diabetologia. 59(11):2321-2330, 2016 11.
VI 1
Record Owner
Status
MEDLINE
Authors
Gellen B; Thorin-Trescases N; Sosner P; Gand E; Saulnier PJ; Ragot S; Fraty M; Laugier S; Ducrocq G;
Montaigne D; Llaty P; Rigalleau V; Zaoui P; Halimi JM; Roussel R; Thorin E; Hadjadj S.
Author NameID
Gellen, Barnabas; ORCID: https://orcid.org/0000-0002-1128-2985
Authors Full Name
Gellen, Barnabas; Thorin-Trescases, Nathalie; Sosner, Philippe; Gand, Elise; Saulnier, Pierre-Jean; Ragot,
Stephanie; Fraty, Mathilde; Laugier, Stephanie; Ducrocq, Gregory; Montaigne, David; Llaty, Pierre;
Rigalleau, Vincent; Zaoui, Philippe; Halimi, Jean-Michel; Roussel, Ronan; Thorin, Eric; Hadjadj, Samy.
Institution
Gellen, Barnabas. ELSAN, Polyclinique de Poitiers, 1 Rue de la Providence, F-8600, Poitiers, France.
barnabas.gellen.cardio@gmail.com.
Gellen, Barnabas. Department of Cardiology, CHU Henri Mondor, Creteil, France.
Gellen, Barnabas. Faculte de Medecine et Pharmacie, Universite de Poitiers, Poitiers, France.
Thorin-Trescases, Nathalie. Department of Surgery, Faculty of Medicine, Universite de Montreal,
Montreal Heart Institute, Montreal, QC, Canada.
Sosner, Philippe. CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France.
Sosner, Philippe. Universite de Poitiers, Laboratoire MOVE (EA 6314), Poitiers, France.
Sosner, Philippe. Centre Medico-Sportif Mon Stade, Paris, France.
Gand, Elise. CHU de Poitiers, Pole Dune, Poitiers, France.
Page 21
Saulnier, Pierre-Jean. CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France.
Saulnier, Pierre-Jean. Inserm, CIC 1402, Poitiers, France.
Saulnier, Pierre-Jean. UFR Medecine Pharmacie, Universite de Poitiers, Poitiers, France.
Ragot, Stephanie. CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France.
Fraty, Mathilde. CHU de Poitiers, Pole Dune, Poitiers, France.
Laugier, Stephanie. UFR Medecine Pharmacie, Universite de Poitiers, Poitiers, France.
Laugier, Stephanie. Endocrinologie-Diabetologie, CHU de Poitiers, Poitiers, France.
Ducrocq, Gregory. Departement Hospitalo-Universitaire FIRE, APHP, Hopital Bichat, Paris, France.
Ducrocq, Gregory. Faculte de Medecine, Universite Paris Diderot, Sorbonne Paris Cite, Paris, France.
Ducrocq, Gregory. Inserm U-1148, Paris, France.
Montaigne, David. CHU Lille, Service d'Explorations Fonctionnelles Cardiovasculaires, Hopital
Cardiologique, Lille, France.
Montaigne, David. Faculte de Medecine, Universite de Lille, Lille, France.
Montaigne, David. Inserm U1011, Lille, France.
Montaigne, David. EGID, Lille, France.
Montaigne, David. Institut Pasteur de Lille, Lille, France.
Llaty, Pierre. CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France.
Rigalleau, Vincent. CHU Bordeaux, Haut-Leveque Hospital, Nutrition-Diabetology Department, Pessac,
France.
Zaoui, Philippe. CHU de Grenoble, Service Nephrologie, Dialyse et Transplantation, Grenoble, France.
Zaoui, Philippe. Faculte de Medecine, Universite Joseph Fournier, Grenoble, France.
Halimi, Jean-Michel. CHU de Tours, Service Nephrologie, Dialyse et Transplantation, Tours, France.
Roussel, Ronan. Departement Hospitalo-Universitaire FIRE, APHP, Hopital Bichat, Paris, France.
Roussel, Ronan. Faculte de Medecine, Universite Paris Diderot, Sorbonne Paris Cite, Paris, France.
Thorin, Eric. Department of Surgery, Faculty of Medicine, Universite de Montreal, Montreal Heart
Institute, Montreal, QC, Canada.
Hadjadj, Samy. CHU de Poitiers Centre d'Investigation Clinique, Poitiers, France.
Hadjadj, Samy. Inserm, CIC 1402, Poitiers, France.
Hadjadj, Samy. UFR Medecine Pharmacie, Universite de Poitiers, Poitiers, France.
Hadjadj, Samy. Endocrinologie-Diabetologie, CHU de Poitiers, Poitiers, France.
Hadjadj, Samy. Inserm U1082, Poitiers, France.
Aged
Angiopoietin-like Proteins
*Angiopoietins/bl [Blood]
Cardiovascular Diseases/bl [Blood]
Cardiovascular Diseases/ep [Epidemiology]
Cardiovascular Diseases/mo [Mortality]
*Diabetes Mellitus, Type 2/bl [Blood]
Diabetes Mellitus, Type 2/ep [Epidemiology]
*Diabetes Mellitus, Type 2/mo [Mortality]
Female
Humans
Male
Middle Aged
Myocardial Infarction/bl [Blood]
Myocardial Infarction/ep [Epidemiology]
Myocardial Infarction/mo [Mortality]
Prospective Studies
Risk Factors
Stroke/bl [Blood]
Stroke/ep [Epidemiology]
Stroke/mo [Mortality]
Keyword Heading
*ANGPTL2
Page 22
*Angiopoietin-like 2
*Biomarker
*Death
*MACE
*Type 2 diabetes
Abstract
AIMS/HYPOTHESIS: A high serum angiopoietin-like 2 (ANGPTL2) concentration is an independent
risk factor for developing diabetes and is associated with insulin resistance and atherosclerosis. In this
work, we have examined the impact of serum ANGPTL2 on improving cardiovascular (CV) risk
stratification in patients with type 2 diabetes.
METHODS: A prospective, monocentric cohort of consecutive type 2 diabetes patients (the

SURDIAGENE cohort; total of 1353 type 2 diabetes patients; 58% men, mean +/- SD age 64 +/- 11 years)
was followed for a median of 6.0 years for death as primary endpoint and major adverse CV events
(MACE; i.e. CV death, myocardial infarction or stroke) as a secondary endpoint. Patients with end-stage
renal disease, defined as a requirement for dialysis or a history of kidney transplantation, were excluded.
Patients were grouped into quartiles according to ANGPTL2 concentrations at inclusion: <11.2 (Q1), 11.2-
14.7 (Q2), 14.8-19.5 (Q3) or >19.5 (Q4) ng/ml.
RESULTS: During follow up, 367 patients (representing 4.5% of the total person-years) died and 290
patients (representing 3.7% of the total person-years) presented with MACE. Both the survival and MACE-
free survival rates were significantly different between ANGPTL2 quartiles (logrank 82.12, p < 0.0001 for
death; and logrank 65.14, p < 0.0001 for MACE). Patients with ANGPTL2 concentrations higher than 19.5
ng/ml (Q4) had a significantly higher risk of death and MACE than those with ANGPTL2 levels of 19.5
ng/ml or less (Q1-3) (HR for death 2.44 [95% CI 1.98, 3.00], p < 0.0001; HR for MACE 2.43 [95% CI
1.92, 3.06], p < 0.0001) after adjustment for sex, age and established CV risk factors. Using ANGPTL2
concentrations, prediction of the risk of mortality, as assessed by integrated discrimination improvement
(IDI), was significantly improved (IDI 0.006 +/- 0.002, p = 0.0002).
CONCLUSIONS/INTERPRETATION: In patients with type 2 diabetes, serum ANGPTL2

concentrations were independently associated with death and MACE. Therefore, ANGPTL2 is a promising
candidate biomarker for improving risk stratification in type 2 diabetes patients, and may prove to be a
valuable therapeutic target.
0 (ANGPTL2 protein, human). 0 (Angiopoietin-like Proteins). 0 (Angiopoietins). 0 (Biomarkers).
Publication Type
Year of Publication
2016

<115>
Unique Identifier
27486667
Title
Significant Association between Toll-Like Receptor Gene Polymorphisms and Posttransplantation
Diabetes Mellitus.
Source
Nephron. 133(4):279-86, 2016.
VI 1
Record Owner
Page 23
Status
MEDLINE
Authors
Kim JS; Kim SK; Park JY; Kim YG; Moon JY; Lee SH; Ihm CG; Lee TW; Kim SK; Chung JH; Kang
SW; Kim TH; Kim YH; Jeong KH.
Authors Full Name
Kim, Jin Sug; Kim, Seul Ki; Park, Ji Yoon; Kim, Yang Gyun; Moon, Joo Young; Lee, Sang Ho; Ihm,
Chun Gyoo; Lee, Tae Won; Kim, Su Kang; Chung, Joo-Ho; Kang, Sun Woo; Kim, Tae Hee; Kim, Yeong
Hoon; Jeong, Kyung Hwan.
Institution
Kim, Jin Sug. Division of Nephrology, School of Medicine, Kyung Hee University, Seoul, Republic of
Korea.
Adult
Female
Humans
Male
Middle Aged
*Polymorphism, Single Nucleotide
Republic of Korea
*Toll-Like Receptor 4/ge [Genetics]
*Toll-Like Receptor 6/ge [Genetics]
*Toll-Like Receptors/ge [Genetics]
Abstract
BACKGROUND: Posttransplantation diabetes mellitus (PTDM) is an important metabolic complication
after renal transplantation. Activation of the innate immune system via toll-like receptors (TLRs) is
implicated in the pathogenesis of insulin resistance and deficiency. Although links between diabetes,
dysregulated innate immune responses, and the TLR signaling pathway have been reported, no study so far
has investigated their associations with PTDM. In this study, we ascertained whether single nucleotide
polymorphisms (SNPs) in TLRs are associated with PTDM in the Korea population.
METHODS: A total of 305 patients who received renal transplants without previously diagnosed diabetes
were included. We analyzed the association between PTDM development and 6 SNPs within 2 genes of
TLR2, 1 gene of TLR4, and 3 genes of TRL6.
RESULTS: Of 305 patients, PTDM developed in 51 patients (16.6%). Patients in the PTDM group were
older than those in the non-PTDM group (45.56 +/- 1.28 vs. 38.28 +/- 0.71 years). Patients with PTDM had
significantly higher allele frequency compared to those without PTDM for the TLR4 rs1927914*T, TLR6
rs3775073*A, TLR6 rs3821985*C, and TLR6 rs1039559*C alleles. Of the 6 SNPs, rs1927914 in the TLR4
gene and rs1039559 in the TLR6 gene were significantly associated with the development of PTDM after
adjustment for age, gender, and tacrolimus usage.
CONCLUSIONS: Our study demonstrates a significant association between SNPs rs1927914 in TLR4
and rs1039559 in TLR6 and PTDM in the renal transplantation recipient group. These data suggest that the
activation of the innate immune system and inflammation via TLR activation might have an essential role
in the pathogenesis of PTDM in renal transplantation. Copyright © 2016 S. Karger AG, Basel.
0 (TLR4 protein, human). 0 (TLR6 protein, human). 0 (Toll-Like Receptor 4). 0 (Toll-Like Receptor 6). 0
(Toll-Like Receptors).
Publication Type
Journal Article.
Year of Publication
2016
Page 24
<116>
Unique Identifier
27317270
Title
The Effect of Corticosteroid Withdrawal on Glucose Metabolism and Anti-GAD Antibodies in
Simultaneous Pancreas-Kidney Transplant Patients.
Source
Progress in Transplantation. 26(3):249-54, 2016 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Ribeiro RS; Cristelli M; Amor AJ; Guerrero V; Ferrer J; Ricart MJ; Esmatjes E.
Authors Full Name
Ribeiro, Rogerio Silicani; Cristelli, Marina; Amor, Antonio J; Guerrero, Vanessa; Ferrer, Joana; Ricart,
Maria Jose; Esmatjes, Enric.
Institution
Ribeiro, Rogerio Silicani. Diabetes Unit, Hospital Clinic de Barcelona, Barcelona, Spain Diabetes
Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
Cristelli, Marina. Renal Transplant Unit, Hospital Clinic de Barcelona, Barcelona, Spain Hospital do
Rim, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.
Amor, Antonio J. Diabetes Unit, Hospital Clinic de Barcelona, Barcelona, Spain.
Guerrero, Vanessa. Renal Transplant Unit, Hospital Clinic de Barcelona, Barcelona, Spain.
Ferrer, Joana. Surgery Department, Hospital Clinic de Barcelona, Barcelona, Spain.
Ricart, Maria Jose. Renal Transplant Unit, Hospital Clinic de Barcelona, Barcelona, Spain.
Esmatjes, Enric. Diabetes Unit, Hospital Clinic de Barcelona, Barcelona, Spain esmatjes@clinic.ub.es.
*Adrenal Cortex Hormones/ad [Administration & Dosage]
*Autoantibodies
Blood Glucose
Diabetes Mellitus, Type 1
Follow-Up Studies
*Glucose/me [Metabolism]
Humans
Insulin
*Pancreas Transplantation
Retrospective Studies
Keyword Heading
anti-GAD antibodies
corticosteroids
glucose metabolism.
simultaneous pancreas-kidney transplantation
type 1 diabetes
Abstract
CONTEXT: Corticosteroid withdrawal may reduce insulin resistance; however, it could also influence
pancreatic autoantibody profile in simultaneous pancreas-kidney (SPK) transplant patients.
Page 25
OBJECTIVE: To evaluate the effect of corticosteroid withdrawal on glucose metabolism and anti-
glutamic acid decarboxylase (GAD) antibody titers in SPK patients with type 1 diabetes after 12 months of
follow-up.
DESIGN: In this retrospective study, fasting glucose and glycated hemoglobin (A1c) were compared
before and after 3, 6, and 12 months of corticosteroid withdrawal in 80 SPK patients. In addition, weight,
anti-GAD, and C-peptide levels were compared before and after withdrawal. Finally, fasting and
postglucose, insulin, and C-peptide levels were compared before and after withdrawal in 25 patients
undergoing oral glucose tolerance test (OGTT).
RESULTS: Fasting glucose levels did not change during corticosteroid discontinuation. After 12 months,
A1c slightly increased from 4.6% (0.4%) to 4.8% (0.6%) (P < .01) and C-peptide decreased from 2.8 (1.1)
ng/mL to 2.4 (1.3) ng/mL (P <. 01). In patients submitted to OGTT, glucose, insulin, and C-peptide levels
did not change. There was no alteration in the proportion of anti-GAD positive tests (41% vs 45%). Anti-
GAD titers remained stable or decreased in 70% of positive patients.
CONCLUSION: Corticosteroid withdrawal has no significant effect on glucose metabolism and on anti-
GAD profile among SPK patients. Copyright © 2016, NATCO.
0 (Adrenal Cortex Hormones). 0 (Autoantibodies). 0 (Blood Glucose). 0 (Insulin). IY9XDZ35W2
(Glucose).
Publication Type
Journal Article.
Year of Publication
2016

<117>
Unique Identifier
27283100
Title
Effects of metabolic syndrome on kidney transplantation outcomes: a systematic review and meta-
analysis. [Review]
Source
Transplant International. 29(10):1059-66, 2016 Oct.
VI 1
Record Owner
Status
MEDLINE
Authors
Pedrollo EF; Correa C; Nicoletto BB; Manfro RC; Leitao CB; Souza GC; Goncalves LF.
Authors Full Name
Pedrollo, Elis F; Correa, Camila; Nicoletto, Bruna B; Manfro, Roberto C; Leitao, Cristiane B; Souza,
Gabriela C; Goncalves, Luiz Felipe S.
Institution
Pedrollo, Elis F. Programa de Pos-Graduacao em Medicina: Ciencias Medicas, Universidade Federal do
Rio Grande do Sul, Porto Alegre, Brazil.
Correa, Camila. Programa de Pos-Graduacao em Medicina: Ciencias Medicas, Universidade Federal do
Rio Grande do Sul, Porto Alegre, Brazil.
Page 26
Nicoletto, Bruna B. Programa de Pos-Graduacao em Ciencias Medicas: Endocrinologia, Universidade
Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Manfro, Roberto C. Programa de Pos-Graduacao em Medicina: Ciencias Medicas, Universidade Federal
do Rio Grande do Sul, Porto Alegre, Brazil.
Manfro, Roberto C. Department of Internal Medicine, School of Medicine, Universidade Federal do Rio
Grande do Sul, Porto Alegre, Brazil.
Manfro, Roberto C. Division of Nephrology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
Leitao, Cristiane B. Programa de Pos-Graduacao em Ciencias Medicas: Endocrinologia, Universidade
Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Leitao, Cristiane B. Division of Endocrinology, Hospital de Clinicas de Porto Alegre, Porto Alegre,
Brazil.
Souza, Gabriela C. Department of Nutrition, School of Medicine, Universidade Federal do Rio Grande do
Sul, Porto Alegre, Brazil.
Souza, Gabriela C. Division of Nutrition, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
Goncalves, Luiz Felipe S. Programa de Pos-Graduacao em Medicina: Ciencias Medicas, Universidade
Federal do Rio Grande do Sul, Porto Alegre, Brazil. lfgoncalves@hcpa.edu.br.
Goncalves, Luiz Felipe S. Department of Internal Medicine, School of Medicine, Universidade Federal
do Rio Grande do Sul, Porto Alegre, Brazil. lfgoncalves@hcpa.edu.br.
Goncalves, Luiz Felipe S. Division of Nephrology, Hospital de Clinicas de Porto Alegre, Porto Alegre,
Brazil. lfgoncalves@hcpa.edu.br.
Adult
*Cardiovascular Diseases/mo [Mortality]
Female
*Graft Rejection/mo [Mortality]
Humans
Immunosuppressive Agents/tu [Therapeutic Use]
Kidney Failure, Chronic/co [Complications]
*Kidney Transplantation/mo [Mortality]
Male
Metabolic Syndrome/co [Complications]
*Metabolic Syndrome/mo [Mortality]
Middle Aged
Randomized Controlled Trials as Topic
Risk
Risk Factors
Keyword Heading
death by cardiovascular disease
graft loss
metabolic syndrome
Abstract
Metabolic syndrome (MS) has been associated with proteinuria and reduced glomerular filtration rate.
Immunosuppressive agents increase the incidence of traditional risk factors for cardiovascular disease
(CVD) and have known effects on MS components after kidney transplantation. The purpose of this meta-
analysis was to evaluate the impact of MS on relevant outcomes after kidney transplantation. MEDLINE,
EMBASE, and Cochrane Library were searched up to November 7, 2015. Papers that compared patients
with and without MS and assessed one of the following outcomes, graft loss, death by cardiovascular
disease, and all-cause mortality, were included. Of 585 studies identified, five studies including 1269
patients were evaluated. MS was identified as a risk factor for graft loss [relative risk, 3.06; 95%
confidence interval (CI), 2.17, 4.32; I2 = 0%; P heterogeneity = 0.72] and death by CVD (relative risk,
3.53; 95% CI, 1.27, 9.85; I2 = 0%; P heterogeneity = 0.40). Results on the association between MS and all-
cause mortality were inconclusive (relative risk, 2.61; 95% CI, 0.70, 9.81; I2 = 58%; P heterogeneity =
0.09). Graft loss and death by CVD were associated with the presence of MS after transplantation.
Page 27
Randomized clinical trials should be conducted to define whether interventions on each MS component
would result in better outcomes after transplantation. Copyright © 2016 Steunstichting ESOT.
Publication Type
Journal Article. Meta-Analysis. Review. Systematic Review.
Year of Publication
2016

<118>
Unique Identifier
27234753
Title
Matrix Metalloproteinase Gene Polymorphisms and New-Onset Diabetes After Kidney Transplantation in
Korean Renal Transplant Subjects.
Source
Transplantation Proceedings. 48(3):858-63, 2016 Apr.
VI 1
Record Owner
Status
MEDLINE
Authors
Ong S; Kang SW; Kim YH; Kim TH; Jeong KH; Kim SK; Yoon YC; Seo SK; Moon JY; Lee SH; Ihm
CG; Lee TW; Chung JH.
Authors Full Name
Ong, S; Kang, S-W; Kim, Y-H; Kim, T-H; Jeong, K-H; Kim, S-K; Yoon, Y-C; Seo, S-K; Moon, J-Y; Lee,
S-H; Ihm, C-G; Lee, T-W; Chung, J-H.
Institution
Ong, S. Department of Nephrology, College of Medicine, Inje University, Busan, Korea.
Kang, S-W. Department of Nephrology, College of Medicine, Inje University, Busan, Korea. Electronic
address: kswnephrology@hotmail.com.
Kim, Y-H. Department of Nephrology, College of Medicine, Inje University, Busan, Korea.
Kim, T-H. Department of Nephrology, College of Medicine, Inje University, Busan, Korea.
Jeong, K-H. Department of Nephrology, College of Medicine, Kyung Hee University, Seoul, Korea.
Kim, S-K. Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul,
Korea.
Yoon, Y-C. Department of Chest Surgery, College of Medicine, Inje University, Busan, Korea.
Seo, S-K. Department of Microbiology and Immunology, College of Medicine, Inje University, Busan,
Korea.
Moon, J-Y. Department of Nephrology, College of Medicine, Kyung Hee University, Seoul, Korea.
Lee, S-H. Department of Nephrology, College of Medicine, Kyung Hee University, Seoul, Korea.
Ihm, C-G. Department of Nephrology, College of Medicine, Kyung Hee University, Seoul, Korea.
Lee, T-W. Department of Nephrology, College of Medicine, Kyung Hee University, Seoul, Korea.
Chung, J-H. Kohwang Medical Research Institute, School of Medicine, Kyung Hee University, Seoul,
Korea.
Adult
Asian Continental Ancestry Group
*Diabetes Mellitus, Type 2/ge [Genetics]
Page 28
Female
Gene Frequency
Genetic Markers
Humans
Male
*Matrix Metalloproteinase 2/ge [Genetics]
Middle Aged
*Polymorphism, Single Nucleotide
Republic of Korea
Risk Factors
Abstract
BACKGROUND: New-onset diabetes after transplantation (NODAT) is a serious metabolic complication
that may follow renal transplantation. Matrix metalloproteinases (MMPs) contribute to insulin insufficiency
and beta-cell dysfunction in a rat model. The MMP-2 concentrations were lower in patients with type 2
diabetes mellitus, and the plasma MMPs levels were related to diabetes. Similar to the pathogenesis of type
2 diabetes mellitus, insulin resistance and insulin secretion dysfunction occur in patients with the
development of NODAT. Therefore, we examined the association between NODAT and 11 single-
nucleotide polymorphisms (SNPs) located within the 3 genes of MMPs that might be related to NODAT.
METHODS: A total of 309 renal transplant recipients without a history of diabetes were included in this
study. DNA was extracted from the blood samples of recipients, and we analyzed the association between
the development of NODAT and a panel of 11 SNPs within 3 MMP genes (MMP-1, MMP-2, and MMP-3).
RESULTS: In terms of allele frequencies, rs243849*C (MMP-2) was significantly higher in patients with
NODAT. Two of the 11 (18.1%) SNPs were significantly associated with NODAT development after
adjusting for age, sex, and tacrolimus usage: MMP-2 (rs1132896) and MMP-2 (rs243849). In the multiple
logistic regression analysis, these 2 SNPs were significantly associated with the development of NODAT in
the codominant and recessive or codominant and dominant models.
CONCLUSIONS: MMP-2 gene rs1132896 and rs243849 polymorphisms may serve as genetic markers
for the development of NODAT. The exact molecular mechanisms still must be clarified. Copyright ©
2016 Elsevier Inc. All rights reserved.
0 (Genetic Markers). EC 3-4-24-24 (Matrix Metalloproteinase 2).
Publication Type
Journal Article.
Year of Publication
2016

<119>
Unique Identifier
27136250
Title
New-Onset Diabetes After Kidney Transplantation and Pretransplant Hypomagnesemia.
Source
Progress in Transplantation. 26(1):55-61, 2016 Mar.
VI 1
Record Owner
Page 29
Status
MEDLINE
Authors
Sinangil A; Celik V; Barlas S; Sakaci T; Koc Y; Basturk T; Akin EB; Ecder T.
Authors Full Name
Sinangil, Ayse; Celik, Vedat; Barlas, Soykan; Sakaci, Tamer; Koc, Yener; Basturk, Taner; Akin, Emin
Baris; Ecder, Tevfik.
Institution
Sinangil, Ayse. Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University,
Istanbul, Turkey ayse.sinangil@istanbulbilim.edu.tr.
Celik, Vedat. Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University,
Istanbul, Turkey.
Barlas, Soykan. Renal Transplantation Unit, Istanbul Bilim University, Istanbul, Turkey.
Sakaci, Tamer. Clinical Nephrology, Sisli Hamidiye Etfal Research and Educational Hospital, Istanbul,
Turkey.
Koc, Yener. Clinical Nephrology, Sisli Hamidiye Etfal Research and Educational Hospital, Istanbul,
Turkey.
Basturk, Taner. Clinical Nephrology, Sisli Hamidiye Etfal Research and Educational Hospital, Istanbul,
Turkey.
Akin, Emin Baris. Renal Transplantation Unit, Istanbul Bilim University, Istanbul, Turkey.
Ecder, Tevfik. Division of Nephrology, Department of Internal Medicine, Istanbul Bilim University,
Istanbul, Turkey.
Adult
Age Factors
Body Mass Index
Cyclosporine/tu [Therapeutic Use]
Female
*Graft Rejection/pc [Prevention & Control]
Humans
*Immunosuppressive Agents/tu [Therapeutic Use]
Insulin Resistance
Kidney Failure, Chronic/bl [Blood]
*Magnesium/bl [Blood]
Male
Middle Aged
Mycophenolic Acid/aa [Analogs & Derivatives]
Mycophenolic Acid/tu [Therapeutic Use]
*Overweight/ep [Epidemiology]
Risk Factors
TOR Serine-Threonine Kinases/ai [Antagonists & Inhibitors]
Tacrolimus/tu [Therapeutic Use]
*Water-Electrolyte Imbalance/ep [Epidemiology]
Keyword Heading
NODAT
pretransplant hypomagnesemia
Abstract
AIM: Hypomagnesemia is a frequent finding in kidney transplant patients and plays a causal role in
insulin resistance and diabetes. The aim of this study was to investigate whether the pretransplant
magnesium (Mg) level is a risk factor for the development of new-onset diabetes after kidney
Page 30
transplantation (NODAT) and the presence of relationship between pretransplant hypomagnesemia and the
development period of NODAT.
METHODS: Four hundred and nineteen nondiabetic renal transplant recipients were evaluated
retrospectively. The patients were divided into NODAT and non-NODAT groups. The time of diagnosis of
patients with NODAT was divided into 0 to 3, 3 to 6, 6 to 12 months, and after 12 months. Patients'
characteristics and pretransplant Mg levels in NODAT were compared with non-NODAT, and it was
investigated whether pretransplant hypomagnesemia was a risk factor for the development of NODAT.
RESULTS: Totally 70 (16.6%) patients (36 female [F], mean age 51.7 +/- 8.2 years) were diagnosed with
NODAT. Three hundred and forty-nine patients (115 F, mean age 43.2 +/- 12.5 years) did not have
NODAT. Pretransplant mean Mg level was 1.97 +/- 0.40 mg/dL in patients with NODAT, while it was 2.5
+/- 0.45 mg/dL in non-NODAT patients (P < .001). Serum Mg level was found to be similar in subgroups
according to the development period of NODAT (P = .07). When patients were stratified according to
quartiles of Mg level, the frequency of NODAT was significantly higher in patients in the lower quartile
(Mg < 2.1 mg/dL; P < .001). Older age, high body mass index, and low pretransplant serum Mg levels were
established as risk factors for developing NODAT. According to the quartile of Mg level, the risk of
developing NODAT was highest in the lowest quartile.
CONCLUSION: Pretransplant hypomagnesemia is an independent risk factor of NODAT. Therefore, it is

necessary to closely monitor the Mg levels in the posttransplant period. Copyright © 2016, NATCO.
0 (Immunosuppressive Agents). 83HN0GTJ6D (Cyclosporine). EC 2-7-1-1 (TOR Serine-Threonine
Kinases). HU9DX48N0T (Mycophenolic Acid). I38ZP9992A (Magnesium). WM0HAQ4WNM
(Tacrolimus).
Publication Type
Journal Article.
Year of Publication
2016

<120>
Unique Identifier
26709897
Title
Glucometabolic disease in the kidney transplant patient. [Review]
Source
Frontiers in Bioscience. 8:67-78, 2016 Jan 01.
VI 1
Record Owner
Status
MEDLINE
Authors
Sadhu AR; Steenkamp D; McDonnell ME.
Authors Full Name
Sadhu, Archana R; Steenkamp, Devin; McDonnell, Marie E.
Institution
Sadhu, Archana R. Weill Cornell Medical College at Houston Methodist Hospital, Houston, Texas.
Steenkamp, Devin. 2Boston University School of Medicine, Department of Medicine, Section of
Endocrinology, Boston, Massachusetts.
Page 31
McDonnell, Marie E. Harvard School of Medicine, Department of Medicine, Division of Endocrinology
Boston, Massachusetts, memcdonnell@partners.org.
Diabetes Mellitus/th [Therapy]
Humans
Kidney Failure, Chronic/me [Metabolism]
Metabolic Syndrome/ep [Epidemiology]
Obesity/ep [Epidemiology]
Postoperative Complications/th [Therapy]
Risk Factors
Abstract
The comprehensive care of the kidney transplant (KT) patient includes a broad clinical assessment to
detect and stage metabolic disease both before and after transplantation. In this review, the metabolic
consequences of KT in both the short and long term will be explored in the context of new data and a
synthesis proposed based upon what has been studied for over two decades. A review of the changes in
epidemiology introduces a discussion of the current state of the literature for the diagnosis and management
of diabetes after KT, obesity and the metabolic syndrome.
Publication Type
Year of Publication
2016

<121>
Unique Identifier
26656280
Title
Impact of Resistance Training on Factors Involved in the Development of New-Onset Diabetes After
Transplantation in Renal Transplant Recipients: An Open Randomized Pilot Study.
Source
Canadian Journal of Diabetes. 40(5):382-388, 2016 Oct.
VI 1
Record Owner
Status
MEDLINE
Authors
Karelis AD; Hebert MJ; Rabasa-Lhoret R; Rakel A.
Authors Full Name
Karelis, Antony D; Hebert, Marie-Josee; Rabasa-Lhoret, Remi; Rakel, Agnes.
Institution
Page 32
Karelis, Antony D. Department of Exercise Science, Universite du Quebec a Montreal, Montreal, Quebec,
Canada; Institut de Recherches Cliniques de Montreal (IRCM), Montreal, Quebec, Canada.
Hebert, Marie-Josee. University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec,
Canada.
Rabasa-Lhoret, Remi. University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec,
Canada; Department of Nutrition, Universite de Montreal, Montreal, Quebec, Canada; Institut de
Recherches Cliniques de Montreal (IRCM), Montreal, Quebec, Canada.
Rakel, Agnes. University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada.
Electronic address: agnes.rakel@umontreal.ca.
Adult
Body Composition
Diabetes Mellitus/et [Etiology]
*Diabetes Mellitus/pc [Prevention & Control]
Female
Humans
Insulin Resistance
Male
Middle Aged
Pilot Projects
*Postoperative Complications
Random Allocation
*Resistance Training
Risk Factors
Keyword Heading
cardiometabolic risk insulin sensitivity
diabete de novo apres transplantation
entrainement musculaire
new onset diabetes after transplantation
resistance training
risque cardiometabolique
sensibilite a l'insuline
transplantation renale
Abstract
OBJECTIVES: New-onsetdiabetes after transplant (NODAT) is a major contributor to cardiovascular
disease after transplantation. Kidney transplantation (KT) recipients have low levels of exercise capacity.
Resistance training (RT) might be of special benefit in this population because underlying disease and
immunosuppressive drugs favour muscle loss and insulin resistance. The aim of this study was to assess the
feasibility of implementing an RT program within a population of KT recipients and its impact on the
incidence of NODAT and cardiometabolic risk factors.
METHODS: This pilot study was an open-randomized study. We randomized 24 patients with a 1:1
allocation to 2 parallel groups, the exercise group (E) or the control group (C). The E group was submitted
to RT 3 times a week for 16 weeks. Anthropometric, body composition, cardiometabolic risk factors,
muscle strength, cardiorespiratory fitness and well-being were measured before and after 16 weeks.
RESULTS: Of the 24 recruited participants, 20 completed the study (10 in the E group and 10 in the C
group). No injuries were reported. The intervention was associated with a significant increase in muscle
strength (p=0.003). A significant group effect, in favour of the E group, was detected for the well-being
score (p=0.03). However, no changes in body composition, cardiometabolic risk factors or
cardiorespiratory fitness were noted for either group after the intervention.
Page 33
CONCLUSIONS: This pilot study suggests that RT appears to be secure and feasible and improves
strength and well-being in patients after KT. However, it does not improve cardiometabolic risk factors.
Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2016

<122>
Unique Identifier
26538615
Title
Clinical evolution of post-transplant diabetes mellitus.
Source
Nephrology Dialysis Transplantation. 31(3):495-505, 2016 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Porrini EL; Diaz JM; Moreso F; Delgado Mallen PI; Silva Torres I; Ibernon M; Bayes-Genis B; Benitez-
Ruiz R; Lampreabe I; Lauzurrica R; Osorio JM; Osuna A; Dominguez-Rollan R; Ruiz JC; Jimenez-Sosa A;
Gonzalez-Rinne A; Marrero-Miranda D; Macia M; Garcia J; Torres A.
Authors Full Name
Porrini, Esteban L; Diaz, Jose M; Moreso, Francisco; Delgado Mallen, Patricia I; Silva Torres, Irene;
Ibernon, Meritxell; Bayes-Genis, Beatriz; Benitez-Ruiz, Rocio; Lampreabe, Ildefonso; Lauzurrica, Ricardo;
Osorio, Jose M; Osuna, Antonio; Dominguez-Rollan, Rosa; Ruiz, Juan C; Jimenez-Sosa, Alejandro;
Gonzalez-Rinne, Ana; Marrero-Miranda, Domingo; Macia, Manuel; Garcia, Javier; Torres, Armando.
Institution
Porrini, Esteban L. Center for Biomedical Research of the Canary Islands (CIBICAN), University of La
Laguna, Tenerife, Spain.
Diaz, Jose M. Nephrology Unit, Fundacion Puigvert (FP), Barcelona, Spain.
Moreso, Francisco. Nephrology Unit, Hospital Val dHebron, Barcelona, Spain.
Delgado Mallen, Patricia I. Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna,
Spain.
Silva Torres, Irene. Nephrology Unit, Fundacion Puigvert (FP), Barcelona, Spain.
Ibernon, Meritxell. Nephrology Unit, Hospital Val dHebron, Barcelona, Spain.
Bayes-Genis, Beatriz. Nephrology Unit, Hospital Germans Trias y Puyol, Badalona, Spain.
Benitez-Ruiz, Rocio. Research Unit, Nephrology Unit, Hospital de Cruces, Bilbao, Spain.
Lampreabe, Ildefonso. Research Unit, Nephrology Unit, Hospital de Cruces, Bilbao, Spain.
Lauzurrica, Ricardo. Nephrology Unit, Hospital Germans Trias y Puyol, Badalona, Spain.
Osorio, Jose M. Nephrology Section, Hospital Nuestra Senora Virgen de las Nieves, Granada, Spain.
Osuna, Antonio. Nephrology Section, Hospital Nuestra Senora Virgen de las Nieves, Granada, Spain.
Dominguez-Rollan, Rosa. Nephrology Unit, Hospital Marques de Valdecilla, Santander, Spain.
Ruiz, Juan C. Nephrology Unit, Hospital Marques de Valdecilla, Santander, Spain.
Jimenez-Sosa, Alejandro. Research Unit, Hospital Univesitario de Canarias, Tenerife, Spain.
Gonzalez-Rinne, Ana. Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
Marrero-Miranda, Domingo. Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna,
Spain.
Page 34
Macia, Manuel. Nephrology Unit, Hospital Universitario Nuestra Senora de la Candelaria, Tenerife,
Spain.
Garcia, Javier. Nephrology Unit, Hospital Universitario Nuestra Senora de la Candelaria, Tenerife, Spain.
Torres, Armando. Center for Biomedical Research of the Canary Islands (CIBICAN), University of La
Laguna, Tenerife, Spain Nephrology Unit, Hospital Universitario de Canarias (HUC), La Laguna, Spain.
Adult
Diabetes Mellitus/bl [Blood]
Female
Humans
Incidence
*Insulin Resistance
Male
Middle Aged
Odds Ratio
Prospective Studies
Risk Factors
Spain/ep [Epidemiology]
Keyword Heading
insulin resistance
post-transplant diabetes
prediabetes
Abstract
BACKGROUND: The long-term clinical evolution of prediabetes and post-transplant diabetes mellitus
(PTDM) is unknown.
METHODS: We analysed, in this cohort study, the reversibility, stability and progression of PTDM and
prediabetes in 672 patients using repeated oral glucose tolerance tests (OGTTs) for <=5 years.
RESULTS: Most patients were on tacrolimus, steroids and mycophenolate. About half developed either
PTDM or prediabetes. The incidence of PTDM was 32% and bimodal: early PTDM (<=3 months) and late
PTDM. Early PTDM reverted in 31%; late PTDM developed in patients with post-transplant prediabetes.
The use of OGTTs was necessary to detect around half of PTDM. Pretransplant obesity was a major risk
factor for early PTDM, for its persistence and for late PTDM {odds ratio [OR] 1.18 [95% confidence
interval (CI) 1.09-1.28]}. At 3 months, higher HbA1c promoted [OR 2.37 (95% CI 1.38-4.06)], while
insulin sensitivity protected against [OR 0.64 (95% CI 0.48-0.86)] late PTDM. At 3 months, 28% had
prediabetes; of these, 36% remained stable, 43% normalized and 21% developed late PTDM. Pretransplant
obesity [OR 1.20 (95% CI 1.04-1.39)] and higher HbA1c [OR 3.80 (95% CI 1.45-9.94)] at 3 months
promoted while insulin sensitivity protected against [OR 0.57 (95% CI 0.34-0.95)] evolution from
prediabetes to late PTDM. Immunosuppressive levels or acute rejection did not influence PTDM. Most
(84%) of the patients with normal tests at 3 months remained stable without evolving into PTDM; 14%
developed prediabetes.
CONCLUSIONS: PTDM and prediabetes are very common in renal transplantation. Classic metabolic
factors like obesity, prediabetes and insulin resistance promote the evolution of PTDM and prediabetes.
Patients with normal glucose metabolism rarely develop PTDM. OGTT is necessary to detect PTDM and
prediabetes and thus should be included in clinical practice. Copyright © The Author 2015. Published by
Oxford University Press on behalf of ERA-EDTA. All rights reserved.
Publication Type
Journal Article. Multicenter Study. Research Support, Non-U.S. Gov't.
Page 35
Year of Publication
2016

<123>
Unique Identifier
26485408
Title
Glucose homeostasis after simultaneous pancreas and kidney transplantation: a comparison of subjects
with C-peptide-positive non-type 1 diabetes mellitus and type 1 diabetes mellitus.
Source
Clinical Transplantation. 30(1):52-9, 2016 Jan.
VI 1
Record Owner
Status
MEDLINE
Authors
Chakkera HA; Kudva YC; Chang YH; Heilman RL; Singer AL; Mathur AK; Hewitt WR; Khamash HA;
Huskey JL; Katariya NN; Moss AA; Behmen S; Reddy KS.
Authors Full Name
Chakkera, Harini A; Kudva, Yogish C; Chang, Yu-Hui H; Heilman, Raymond L; Singer, Andrew L;
Mathur, Amit K; Hewitt, Winston R; Khamash, Hasan A; Huskey, Janna L; Katariya, Nitin N; Moss, Adyr
A; Behmen, Senaida; Reddy, Kunam S.
Institution
Chakkera, Harini A. Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Kudva, Yogish C. Division of Endocrinology and Metabolic Diseases, Mayo Clinic, Rochester, MN,
USA.
Chang, Yu-Hui H. Department of Research Biostatistics, Mayo Clinic, Phoenix, AZ, USA.
Heilman, Raymond L. Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Singer, Andrew L. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Mathur, Amit K. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Hewitt, Winston R. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Khamash, Hasan A. Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Huskey, Janna L. Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Katariya, Nitin N. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Moss, Adyr A. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Behmen, Senaida. Division of Nephrology, Mayo Clinic, Phoenix, AZ, USA.
Reddy, Kunam S. Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA.
Adolescent
Adult
Aged
*C-Peptide/me [Metabolism]
Child
Diabetes Mellitus, Type 1/bl [Blood]
*Diabetes Mellitus, Type 1/su [Surgery]
Female
Follow-Up Studies
*Homeostasis/ph [Physiology]
Page 36
Humans
Insulin Resistance
Male
Middle Aged
Prognosis
Prospective Studies
Risk Factors
Young Adult
Keyword Heading
diabetes
insulin resistance
insulin secretion
pancreas transplant
Abstract
BACKGROUND: While simultaneous pancreas kidney transplant (SPKTx) is a therapeutic option for
patients with type 1 diabetes (T1DM) and renal failure, few centers offer SPKTx to "select" non-T1DM
patients. To address concerns that existing insulin resistance may limit the benefits of the pancreas allograft
among non-T1DM, we compared several indices of glucose homeostasis, in "select" non-T1DM and T1DM
patients who received SPKTx.
METHODS: Criteria for "select" non-T1DM included the following: positive C-peptide, BMI <30
kg/m(2) , treatment with oral agents before insulin initiation, and insulin at <1 unit/kg/d. We compared
several indices of glucose homeostasis within 1 yr post-SPKTx among seven "select" patients with non-
T1DM and nine patients with T1DM with similar age, BMI, and immunosuppression. Measurements of
insulin resistance included the following: homeostatic model, insulin sensitivity index, and insulin-glucose
ratio; insulin secretion measures included the following: corrected insulin response.
RESULTS: Non-T1DM had similar pre-transplant metabolic (fasting glucose, HbA1c, blood pressure,
and lipid) parameters to the T1DM cohort. There were no significant differences in the various measures of
insulin resistance and secretion between T1DM and "select" non-T1DM patients.
CONCLUSION: Our results suggest SPKTx should be considered in the therapeutic armamentarium
among carefully select non-T1DM with features of minimal insulin resistance; however, a larger cohort
with longer follow-up is needed to confirm our results. Copyright © 2015 John Wiley & Sons A/S.
Published by John Wiley & Sons Ltd.
0 (Blood Glucose). 0 (C-Peptide).
Publication Type
Clinical Trial. Comparative Study. Journal Article. Observational Study. Research Support, N.I.H.,
Extramural.
Year of Publication
2016

<124>
Unique Identifier
26437275
Title
Page 37
Diagnostic Accuracies of Glycated Hemoglobin, Fructosamine, and Homeostasis Model Assessment of
Insulin Resistance in Predicting Impaired Fasting Glucose, Impaired Glucose Tolerance, or New Onset
Diabetes After Transplantation.
Source
Transplantation. 100(7):1571-9, 2016 07.
VI 1
Record Owner
Status
MEDLINE
Authors
Rosettenstein K; Viecelli A; Yong K; Nguyen HD; Chakera A; Chan D; Dogra G; Lim EM; Wong G; Lim
WH.
Authors Full Name
Rosettenstein, Kerri; Viecelli, Andrea; Yong, Kenneth; Nguyen, Hung Do; Chakera, Aron; Chan, Doris;
Dogra, Gursharan; Lim, Ee Mun; Wong, Germaine; Lim, Wai H.
Institution
Rosettenstein, Kerri. 1 Department of Renal Medicine, Prince of Wales Hospital, Sydney, Australia. 2
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia. 3 School of Medicine and
Pharmacology, University of Western Australia, Perth, Australia. 4 PathWest, Sir Charles Gairdner
Hospital, Perth, Australia. 5 Sydney School of Public Health, University of Sydney, New South Wales,
Australia. 6 Centre for Kidney Research, The Children's Hospital at Westmead, New South Wales,
Australia. 7 Centre for Transplant and Renal Research, Westmead Hospital, New South Wales, Australia.
Adult
Aged
Area Under Curve
*Blood Glucose/an [Analysis]
Body Mass Index
Female
*Fructosamine/an [Analysis]
Glucose Intolerance/bl [Blood]
*Glycated Hemoglobin A/an [Analysis]
Homeostasis
Humans
Immunosuppression
*Insulin Resistance
Male
Middle Aged
Prospective Studies
Renal Insufficiency/bl [Blood]
Renal Insufficiency/co [Complications]
Reproducibility of Results
Risk
Abstract
BACKGROUND: New onset diabetes after transplantation (NODAT) is associated with a 3-fold greater
risk of cardiovascular disease events, with early identification and treatment potentially attenuating this
risk. The optimal screening test to identify those with NODAT remains unclear, and the aim of this study
was to examine the diagnostic accuracies of 4 screening tests in identifying impaired fasting glucose,
impaired glucose tolerance (IGT), and NODAT.
Page 38
METHODS: This is a single-center prospective cohort study of 83 nondiabetic kidney transplant
recipients between 2008 and 2011. Oral glucose tolerance test was considered the gold standard in
identifying IFG/IGT or NODAT. Diagnostic accuracies of random blood glucose, glycated hemoglobin
(HBA1c), fructosamine, and Homeostasis Model Assessment-Insulin Resistance in predicting IFG/IGT or
NODAT were assessed using the area under the receiver operating characteristic curve.
RESULTS: Forty (48%) recipients had IFG/IGT or NODAT. Compared with HBA1c with adjusted area
under the curve (AUC) of 0.88 (95% confidence interval [95% CI], 0.77-0.93), fructosamine was the most
accurate test with adjusted AUC of 0.92 (95% CI, 0.83-0.96). The adjusted AUCs of random blood glucose
and Homeostasis Model Assessment-Insulin Resistance in identifying IFG/IGT were between 0.81 and
0.85. Restricting to identifying IGT/NODAT using 2-hour oral glucose tolerance test (n = 66), fructosamine
was the most accurate diagnostic test with adjusted AUC of 0.93 (95% CI, 0.84-0.99), but not statistically
different to HBA1c with adjusted AUC of 0.88 (95% CI, 0.76-0.96).
CONCLUSIONS: Although HBA1c is an acceptable and widely used screening test in detecting IFG/IGT
or NODAT, fructosamine may be a more accurate diagnostic test but this needs to be further examined in
larger cohorts.
0 (Blood Glucose). 0 (Glycated Hemoglobin A). 4429-04-3 (Fructosamine).
Publication Type
Journal Article.
Year of Publication
2016

<125>
Unique Identifier
26680076
Title
Serum Fetuin A Levels: Are They a Reliable Marker for Hepatic Steatosis and Regional Adiposity in
Renal Transplant Recipients?.
Source
Transplantation Proceedings. 47(9):2703-6, 2015 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Roshdy A; Okash H; Soliman A; Maamoun H; Shaker O; Soliman MA; Hamdy A.
Authors Full Name
Roshdy, A; Okash, H; Soliman, A; Maamoun, H; Shaker, O; Soliman, M A; Hamdy, A.
Institution
Roshdy, A. Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt.
Okash, H. Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt.
Soliman, A. Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt.
Maamoun, H. Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt. Electronic
address: hodamamoun@yahoo.com.
Shaker, O. Chemical Pathology Department, Cairo University, Cairo, Egypt.
Soliman, M A. Internal Medicine and Nephrology Department, Cairo University, Cairo, Egypt.
Hamdy, A. Internal Medicine Department, Cairo University, Cairo, Egypt.
Page 39
*Adiposity/ph [Physiology]
Adult
Enzyme-Linked Immunosorbent Assay
*Fatty Liver/bl [Blood]
Fatty Liver/dg [Diagnostic Imaging]
Female
Humans
Kidney/me [Metabolism]
Male
Middle Aged
Ultrasonography
*alpha-2-HS-Glycoprotein/an [Analysis]
Abstract
BACKGROUND: Fetuin A is a protein expressed in the liver and it is an important inhibitor of ectopic
calcification. High levels of fetuin A correlate with insulin resistance, hepatic steatosis, and regional
adiposity in the general population. The association between hepatic steatosis and fetuin A level in renal
transplant recipients (RTRs) remains unclear.
AIM: The aim of this study was to explore the relationships between fetuin A, hepatic steatosis, and
regional adiposity in RTRs.
METHODS: Data from 44 patients with normal renal functions were included, all subjected to history
taking for clinical data, assessment of central obesity and regional adiposity, assessment of hepatic steatosis
using abdominal ultrasound (US), and measurements of serum fetuin A concentration using enzyme-linked
immunosorbent assay (ELISA) kits.
RESULTS: Our study included 20 females (45.4%) and 24 males (54.6%) with mean age of 41.26 +/-
11.2 years. Twenty-four subjects had hepatic steatosis. Fetuin A level in RTRs with hepatic steatosis with a
mean of 1642.92 +/- 358.91 is significantly higher (P < .001) than those without hepatic steatosis with a
mean of 711.74 +/- 57.85. Serum fetuin A level was positively correlated with regional adiposity (P = .021)
and hepatic steatosis grade (P = .017). Fetuin A level increased with increased duration after renal
transplantation (P < .001). The best cutoff value for detecting entrance into phase 3 or 4 steatosis is fetuin
of 1862 with sensitivity of 88.9% and specificity of 87.7%.
CONCLUSIONS: Fetuin A is positively correlated with hepatic steatosis and regional adiposity in RTRs.
Fetuin increases with increased duration after renal transplantation. Accordingly it may be used as a marker
for hepatic steatosis and regional adiposity in these patients. Copyright © 2015 Elsevier Inc. All rights
reserved.
0 (Biomarkers). 0 (alpha-2-HS-Glycoprotein).
Publication Type
Journal Article.
Year of Publication
2015

<126>
Unique Identifier
Page 40
26398489
Title
Diabetes Mellitus and Prediabetes on Kidney Transplant Waiting List- Prevalence, Metabolic
Phenotyping and Risk Stratification Approach.
Source
PLoS ONE [Electronic Resource]. 10(9):e0134971, 2015.
VI 1
Record Owner
Status
MEDLINE
Authors
Guthoff M; Vosseler D; Langanke J; Nadalin S; Konigsrainer A; Haring HU; Fritsche A; Heyne N.
Authors Full Name
Guthoff, Martina; Vosseler, Dorothea; Langanke, Julia; Nadalin, Silvio; Konigsrainer, Alfred; Haring,
Hans-Ulrich; Fritsche, Andreas; Heyne, Nils.
Institution
Guthoff, Martina. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical
Chemistry, University of Tubingen, Otfried-Muller-Str. 10, 72076, Tubingen, Germany.
Vosseler, Dorothea. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical
Langanke, Julia. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical
Nadalin, Silvio. Dept. of General-, Visceral- and Transplant Surgery, University of Tubingen, Hoppe-
Seyler-Str. 3, 72076, Tubingen, Germany.
Konigsrainer, Alfred. Dept. of General-, Visceral- and Transplant Surgery, University of Tubingen,
Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany.
Haring, Hans-Ulrich. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical
Fritsche, Andreas. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical
Heyne, Nils. Dept. of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry,
University of Tubingen, Otfried-Muller-Str. 10, 72076, Tubingen, Germany.
Adult
Age Factors
Aged
Biomarkers
*Diabetes Mellitus/me [Metabolism]
Female
Glucose/me [Metabolism]
Humans
*Insulin/me [Metabolism]
Insulin Resistance
Male
Middle Aged
*Phenotype
*Prediabetic State
Prevalence
ROC Curve
Risk Factors
*Waiting Lists
Young Adult
Abstract
Page 41
BACKGROUND: Despite a significant prognostic impact, little is known about disturbances in glucose
metabolism among kidney transplant candidates. We assess the prevalence of diabetes mellitus (DM) and
prediabetes on kidney transplant waiting list, its underlying pathophysiology and propose an approach for
individual risk stratification.
METHODS: All patients on active kidney transplant waiting list of a large European university hospital
transplant center were metabolically phenotyped.
RESULTS: Of 138 patients, 76 (55%) had disturbances in glucose metabolism. 22% of patients had
known DM, 3% were newly diagnosed. 30% were detected to have prediabetes. Insulin sensitivity and-
secretion indices allowed for identification of underlying pathophysiology and risk factors. Age
independently affected insulin secretion, resulting in a relative risk for prediabetes of 2.95 (95%CI 1.38-
4.83) with a cut-off at 48 years. Body mass index independently affected insulin sensitivity as a continuous
variable.
CONCLUSIONS: The prevalence of DM or prediabetes on kidney transplant waiting list is as high as

55%, with more than one third of patients previously undiagnosed. Oral glucose tolerance test is mandatory
to detect all patients at risk. Metabolic phenotyping allows for differentiation of underlying
pathophysiology and provides a basis for early individual risk stratification and specific intervention to
improve patient and allograft outcome.
0 (Biomarkers). 0 (Insulin). IY9XDZ35W2 (Glucose).
Publication Type
Year of Publication
2015

<127>
Unique Identifier
26319527
Title
Metabolic Syndrome in Thai Renal Transplant Recipients: A Multicenter Study.
Source
Annals of Transplantation. 20:500-5, 2015 Aug 27.
VI 1
Record Owner
Status
MEDLINE
Authors
Ruangkanchanasetr P; Bunnag S; Vongwiwatana A; Premasathian N; Avihingsanon Y; Gojaseni P;
Supaporn T; Satirapoj B.
Authors Full Name
Ruangkanchanasetr, Prajej; Bunnag, Sakarn; Vongwiwatana, Attapong; Premasathian, Nalinee;
Avihingsanon, Yingyos; Gojaseni, Pongsathorn; Supaporn, Thanom; Satirapoj, Bancha.
Institution
Ruangkanchanasetr, Prajej. Division of Nephrology, Phramongkutklao Hospital, Bangkok, Thailand.
Bunnag, Sakarn. Division of Nephrology, Rajavithi Hospital, Bangkok, Thailand.
Vongwiwatana, Attapong. Division of Nephrology, Siriraj Hospital, Bangkok, Thailand.
Premasathian, Nalinee. Division of Nephrology, Siriraj Hospital, Bangkok, Thailand.
Page 42
Avihingsanon, Yingyos. Division of Nephrology, Chulalongkorn Memorial Hospital, Bangkok, Thailand.
Gojaseni, Pongsathorn. Division of Nephrology, Bhumibol Adulyadej Hospital, Bangkok, Thailand.
Supaporn, Thanom. Division of Nephrology, Phramongkutklao Hospital, Bangkok, Thailand.
Satirapoj, Bancha. Division of Nephrology, Phramongkutklao Hospital, Bangkok, Thailand.
Adult
Cross-Sectional Studies
Female
Humans
Male
*Metabolic Syndrome/et [Etiology]
Middle Aged
Prevalence
Thailand/ep [Epidemiology]
Abstract
BACKGROUND Many renal transplant recipients develop complications such as obesity,
posttransplantation diabetes mellitus, and dyslipidemia. There have been few studies of metabolic
syndrome (MS) in Asian renal transplant recipients. MATERIAL AND METHODS This cross-sectional
study was performed in 303 patients in 5 transplant centers in Bangkok, Thailand. The diagnosis of MS was
based on the criteria of the modified NCEP-ATPIII, and chronic allograft dysfunction was defined as
estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m^2. RESULTS Of 303 recipients, MS was
diagnosed in 94 cases (31.0%) and the prevalence of MS in the first 3 years and after 3 years
posttransplantation were 21.4% and 34.7% (P=0.042), respectively. There was an association between
advanced age and chronic allograft dysfunction and higher prevalence of MS. Regarding non-anti-
hypertensive and non-hypoglycemic medications, m-TOR inhibitor (odds ratio [OR], 2.14; 95% CI, 1.02-
4.5) was associated with the prevalence of MS. Multivariate analysis revealed MS was associated with the
use of beta-blockers (OR, 3.17; 95% CI, 1.88-5.32). Patients with no MS components had 26.9%
prevalence of chronic allograft dysfunction and patients with higher numbers of MS components had
87.5% prevalence of chronic allograft dysfunction, which was significantly different (P=0.022).
CONCLUSIONS Our study revealed that the prevalence of MS was higher in patients with higher numbers
of MS components, especially after 3 years posttransplantation. Presence of more components of MS was
associated with worse renal function in renal transplant recipients.
Publication Type
Journal Article. Multicenter Study.
Year of Publication
2015

<128>
Unique Identifier
26295182
Title
Apelin and New-Onset Diabetes After Transplant in Living Kidney Allograft Recipients.
Source
Experimental & Clinical Transplantation: Official Journal of the Middle East Society for Organ
Transplantation. 13(4):319-23, 2015 Aug.
VI 1
Page 43
Record Owner
Status
MEDLINE
Authors
Nagib AM; El-Diasty A; El Husseny MA; El-Gamal EM; Abbas MH; Refaie AF; Foudas MA.
Authors Full Name
Nagib, Ayman Maher; El-Diasty, Amany; El Husseny, Mona Abo Baker; El-Gamal, Ezz Mohy-eldeen;
Abbas, Mohamed Hamed; Refaie, Ayman Fathy; Foudas, Mohamed Ashraf.
Institution
Nagib, Ayman Maher. Department of Dialysis and Transplantation, The Urology and Nephrology Center,
Mansoura University, Egypt.
Allografts
Apelin
Chi-Square Distribution
Diabetic Nephropathies/bl [Blood]
Diabetic Nephropathies/et [Etiology]
Female
Humans
*Intercellular Signaling Peptides and Proteins/bl [Blood]
Kidney Transplantation/mt [Methods]
*Living Donors
Logistic Models
Male
Multivariate Analysis
Proteinuria/bl [Blood]
Proteinuria/et [Etiology]
Risk Factors
Treatment Outcome
Up-Regulation
Abstract
OBJECTIVES: Apelin, a cytokine mainly secreted by adipocytes and several tissues, includes the
gastrointestinal tract, adipose, brain, kidney, liver, lung, and various sites within the cardiovascular system.
Apelin is closely related to glucose metabolism, and has been proposed to be a promising therapeutic agent
in treating insulin resistance. Apelin and orphaned G-protein-coupled apelin exhibit roles in regulating fluid
homeostasis. Circulating serum apelin suppresses insulin secretion by binding to the G-protein-coupled
apelin receptor on B cells of islets of Langerhans. Several studies also have documented the altered level of
serum apelin in type 2 diabetic patients, but the results remain controversial. This study sought to analyze
apelin levels in new-onset diabetes after transplant.
MATERIALS AND METHODS: Forty-seven diabetic renal transplant recipients were compared with 40
nondiabetic renal transplant recipients. Data were collected for positive family history of diabetes, body
weight, body mass index, blood pressure, and blood chemistry including apelin level. Logistic multiple
analysis were made for statistically significant data on univariate analysis.
RESULTS: Apelin levels were significantly higher among obese, hypercholesterolemia new-onset
diabetes after transplant patients, 428.7 +/- 193.29, 256.8 +/- 128 (P > .001). There was appositive
correlation between serum apelin and proteinuria.
Page 44
CONCLUSIONS: Serum apelin has a high level in new-onset diabetes after transplant, than nondiabetic
patients, and they positively correlate with proteuria in new-onset diabetes after transplant patients.
0 (APLN protein, human). 0 (Apelin). 0 (Biomarkers). 0 (Intercellular Signaling Peptides and Proteins).
Publication Type
Journal Article.
Year of Publication
2015

<129>
Unique Identifier
26156285
Title
High Serum Osteoprotegerin Is Associated with Arterial Stiffness in Kidney Transplant Patients.
Source
Tohoku Journal of Experimental Medicine. 236(4):247-53, 2015 08.
VI 1
Record Owner
Status
MEDLINE
Authors
Hsu BG; Shih MH; Chen YC; Ho GJ; Lin TY; Lee MC.
Authors Full Name
Hsu, Bang-Gee; Shih, Ming-Hui; Chen, Yen-Cheng; Ho, Guan-Jin; Lin, Teng-Yi; Lee, Ming-Che.
Institution
Hsu, Bang-Gee. Division of Nephrology, Buddhist Tzu Chi General Hospital.
Age Factors
Blood Pressure
Body Mass Index
Body Weight
Creatinine/bl [Blood]
Humans
Linear Models
Manometry
*Metabolic Syndrome/pp [Physiopathology]
Osteoprotegerin/ae [Adverse Effects]
*Osteoprotegerin/bl [Blood]
Pulse Wave Analysis
Vascular Stiffness/de [Drug Effects]
*Vascular Stiffness/ph [Physiology]
Abstract
Osteoprotegerin (OPG) is a cytokine that regulates bone resorption by inhibiting osteoclastogenesis, and
OPG has been implicated in the process that causes vascular stiffness. An increase in serum OPG level has
been associated with the development of arterial stiffness. Kidney transplant (KT) patients are susceptible
to aortic stiffness, which is considered to be a predictor of cardiovascular events in this patient population.
Carotid-femoral pulse wave velocity (cfPWV) has emerged as a gold standard for non-invasive evaluation
Page 45
of aortic stiffness. The aim of this study was to evaluate the relationship between serum OPG concentration
and cfPWV among KT patients. Fasting blood samples were obtained from 57 KT patients and their
cfPWV was measured using applanation tonometry. The serum OPG levels were measured using an
enzyme-linked immunosorbent assay. Univariable linear regression analysis showed that the cfPWV in KT
patients was significantly and positively correlated with age, body weight, waist circumference, body mass
index, log-creatinine, systolic blood pressure, diastolic blood pressure, pulse pressure, and the log-OPG
concentration. KT patients with metabolic syndrome had higher cfPWV values than those without
metabolic syndrome (P = 0.036), which indicates a higher incidence of aortic stiffness in this patient
population. Multivariable forward stepwise linear regression analysis of the significant variables showed
that the log-OPG (P = 0.001), the log-creatinine (P = 0.004), and the SBP (P = 0.005) remained as
independent and positive predictors of cfPWV values. These findings indicate that serum OPG levels are
positively associated with cfPWV in KT patients.
0 (Osteoprotegerin). AYI8EX34EU (Creatinine).
Publication Type
Year of Publication
2015

<130>
Unique Identifier
25970153
Title
Visceral fat is better related to impaired glucose metabolism than body mass index after kidney
transplantation.
Source
Transplant International. 28(10):1162-71, 2015 Oct.
VI 1
Record Owner
Status
MEDLINE
Authors
von During ME; Jenssen T; Bollerslev J; Asberg A; Godang K; Eide IA; Dahle DO; Hartmann A.
Authors Full Name
von During, Marit Elizabeth; Jenssen, Trond; Bollerslev, Jens; Asberg, Anders; Godang, Kristin; Eide,
Ivar Anders; Dahle, Dag Olav; Hartmann, Anders.
Institution
von During, Marit Elizabeth. Department of Transplantation Medicine, Section of Nephrology, Oslo
University Hospital, Rikshospitalet, Oslo, Norway.
von During, Marit Elizabeth. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo,
Oslo, Norway.
Jenssen, Trond. Department of Transplantation Medicine, Section of Nephrology, Oslo University
Jenssen, Trond. Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromso,
Norway.
Bollerslev, Jens. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Bollerslev, Jens. Department of Endocrinology, Section of Specialized Endocrinology, Oslo University
Page 46
Asberg, Anders. Department of Transplantation Medicine, Section of Nephrology, Oslo University
Asberg, Anders. Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Asberg, Anders. School of Pharmacy, University of Oslo, Oslo, Norway.
Godang, Kristin. Department of Endocrinology, Section of Specialized Endocrinology, Oslo University
Eide, Ivar Anders. Department of Transplantation Medicine, Section of Nephrology, Oslo University
Eide, Ivar Anders. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Dahle, Dag Olav. Department of Transplantation Medicine, Section of Nephrology, Oslo University
Dahle, Dag Olav. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Hartmann, Anders. Department of Transplantation Medicine, Section of Nephrology, Oslo University
Hartmann, Anders. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo,
Norway.
Absorptiometry, Photon
Adult
Aged
Blood Glucose/an [Analysis]
Body Composition
Body Mass Index
Diabetes Mellitus/ci [Chemically Induced]
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors/ad [Administration & Dosage]
Immunoglobulins, Intravenous
Insulin/bl [Blood]
*Insulin Resistance
Intra-Abdominal Fat/dg [Diagnostic Imaging]
*Intra-Abdominal Fat/me [Metabolism]
Lipids/bl [Blood]
Methylprednisolone/ae [Adverse Effects]
Middle Aged
Postoperative Complications/me [Metabolism]
Prednisolone/ae [Adverse Effects]
Rituximab/tu [Therapeutic Use]
Tissue Donors
Keyword Heading
HOMA-IR index
insulin resistance
new-onset diabetes mellitus
post-transplant diabetes mellitus
visceral fat
Abstract
The role of visceral adipose tissue (VAT) in post-transplant hyperglycaemia is not known. We evaluated
167 patients without diabetes 8-10 weeks after kidney transplantation, performing oral glucose tolerance
Page 47
tests and measuring VAT content from dual-energy X-ray absorptiometry scans. Median VAT weight in
normal glucose tolerance patients was 0.9 kg, impaired fasting glucose patients 1.0 kg, impaired glucose
tolerance patients 1.3 kg and patients with post-transplant diabetes (PTDM) 2.1 kg (P = 0.004, indicating a
difference between groups). Percentage VAT of total body fat was associated with fasting (R(2) = 0.094, P
< 0.001) and 2-h glucose concentration (R(2) = 0.062, P = 0.001), while BMI was only associated with 2-h
glucose concentration (R(2) = 0.029, P = 0.028). An association between BMI and 2-h glucose
concentration was lost in adjusted models, as opposed to the associations between VAT as percentage of
total body fat and glucose concentrations (R(2) = 0.132, P < 0.001 and R(2) = 0.097, P = 0.001,
respectively for fasting and 2-h glucose concentration). In conclusion, VAT is more closely related to
impaired glucose metabolism than BMI after kidney transplantation. The association with central obesity
should encourage additional studies on lifestyle interventions to prevent PTDM. Copyright © 2015
Steunstichting ESOT.
0 (Blood Glucose). 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors). 0 (Immunoglobulins,
Intravenous). 0 (Immunosuppressive Agents). 0 (Insulin). 0 (Lipids). 4F4X42SYQ6 (Rituximab).
9PHQ9Y1OLM (Prednisolone). IY9XDZ35W2 (Glucose). X4W7ZR7023 (Methylprednisolone).
Publication Type
Journal Article.
Year of Publication
2015

<131>
Unique Identifier
25645786
Title
Index high insulin resistance in pancreas-kidney transplantation contributes to poor long-term survival of
the pancreas graft.
Source
Transplantation Proceedings. 47(1):117-9, 2015 Jan-Feb.
VI 1
Record Owner
Status
MEDLINE
Authors
Pendon-Ruiz de Mier V; Navarro Cabello MD; Martinez Vaquera S; Lopez-Andreu M; Aguera Morales
ML; Rodriguez-Benot A; Ruiz Rabelo J; Campos Hernandez P; Requena Tapia MJ; Aljama Garcia P.
Authors Full Name
Pendon-Ruiz de Mier, V; Navarro Cabello, M D; Martinez Vaquera, S; Lopez-Andreu, M; Aguera
Morales, M L; Rodriguez-Benot, A; Ruiz Rabelo, J; Campos Hernandez, P; Requena Tapia, M J; Aljama
Garcia, P.
Institution
Pendon-Ruiz de Mier, V. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain. Electronic
address: mvitoriaprm@gmail.com.
Navarro Cabello, M D. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Martinez Vaquera, S. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Lopez-Andreu, M. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Aguera Morales, M L. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Rodriguez-Benot, A. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Ruiz Rabelo, J. Department of General Surgery, H.U. Reina Sofia, Cordoba, Spain.
Page 48
Campos Hernandez, P. Department of Urology, H.U. Reina Sofia, Cordoba, Spain.
Requena Tapia, M J. Department of Urology, H.U. Reina Sofia, Cordoba, Spain.
Aljama Garcia, P. Department of Nephrology, H.U. Reina Sofia, Cordoba, Spain.
Adult
Body Mass Index
Female
Glycated Hemoglobin A/an [Analysis]
*Glycemic Index/ph [Physiology]
*Graft Survival
Humans
Insulin/bl [Blood]
*Insulin Resistance
Insulin-Secreting Cells/me [Metabolism]
Male
Middle Aged
Pancreas/me [Metabolism]
Peptides/an [Analysis]
Proteinuria
Abstract
BACKGROUND: Pancreas-kidney transplantation (PKT) is the best therapeutic option for diabetic
patients with end-stage renal failure. Peripheral insulin resistance and the percentage of remaining beta-
cells in the PKT have been little studied in medical literature.
METHODS: We analyzed PKT performed in our hospital from January 1992 to January 2014, with
follow-up for 5 years. Metabolic values related to glycemic were studied, namely, proteinuria, peptide C,
glucose, insulin, and glycosylated hemoglobin. We analyzed insulin resistance (homeostatic model
assessment [HOMA]-IR), the percentage of remaining beta-cells (HOMA-beta), and the influence of these
variables on the glycemic profile and graft survival.
RESULTS: In the study period, 156 simultaneous PKT were performed in our center. At 2 years
posttransplantation, the median value of HOMA-IR kidney-pancreas was 4. We compared transplantation
with lower HOMA-IR (<4) and higher HOMA-IR (>4). HOMA-beta (36 [26-67] vs 29 [14-42]; P = .04),
glucose (86 [80-90] vs 81 [74-89]; P = .018), and body mass index (BMI; 24 [21-27] vs 21 [19-24]; P = .
013) were greater in the group HOMA-IR>4 versus HOMA-IR<4 group, respectively, after 3 months.
These differences in glycemic profile were maintained until the first year after transplantation. At 2 and 5
years of follow-up, the HOMA-IR>4 group showed higher glucose levels and greater BMI, but not
differences in HOMA-beta. At 1 and 5 years posttransplantation, pancreatic graft survival in the HOMA-
IR>4 group (82.9% vs 92.5%) was lower compared with the HOMA-IR<4 group (67% vs 87.5%; P = .
016).
CONCLUSIONS: PKT exhibit an altered glycemic profile in the posttransplantation follow-up associated
with the percentage of remaining beta-cells and peripheral insulin resistance. PKT patients with peripheral
insulin resistance showed decreased pancreatic graft survival. Copyright © 2015 Elsevier Inc. All rights
reserved.
0 (Blood Glucose). 0 (Glycated Hemoglobin A). 0 (Insulin). 0 (Peptides). 0 (polypeptide C).
Publication Type
Journal Article.
Year of Publication
2015
Page 49
<132>
Unique Identifier
25644968
Title
Tacrolimus decreases insulin sensitivity without reducing fasting insulin concentration: a 2-year follow-up
study in kidney transplant recipients.
Source
Renal Failure. 37(4):601-6, 2015 May.
VI 1
Record Owner
Status
MEDLINE
Authors
Chen QJ; Li J; Zuo SR; Zhang YP; Jia SJ; Yuan H; Liu SK; Cheng K; Ming YZ; Zuo XC; Luo AJ; Xie
WZ; Cai JJ; Yang M; Wang JL.
Authors Full Name
Chen, Qing-Jie; Li, Jing; Zuo, Shan-Ru; Zhang, Ya-Ping; Jia, Su-Jie; Yuan, Hong; Liu, Shi-Kun; Cheng,
Ke; Ming, Ying-Zi; Zuo, Xiao-Cong; Luo, Ai-Jing; Xie, Wen-Zhao; Cai, Jing-Jing; Yang, Meng; Wang,
Jiang-Lin.
Institution
Chen, Qing-Jie. Clinical Pharmacy and Pharmacology Research Institute, The Third Xiangya Hospital of
Central South University, Changsha, Hunan, PR China .
Adult
Cohort Studies
*Diabetes Mellitus/ci [Chemically Induced]
Diabetes Mellitus/ge [Genetics]
*Fasting/bl [Blood]
Female
Follow-Up Studies
Humans
Immunosuppressive Agents
*Insulin/bl [Blood]
*Insulin Resistance
Male
*Postoperative Complications/ci [Chemically Induced]
Postoperative Complications/ge [Genetics]
Risk Factors
*Tacrolimus/ae [Adverse Effects]
Time Factors
Keyword Heading
IRS-1
IRS-2
PTDM
SNP
Page 50
TAC
Abstract
New Onset Diabetes after Transplantation (NODAT) is defined as sustained hyperglycemia developing in
patients without diabetes history before transplantation. A cohort study was performed to access the effects
of tacrolimus on insulin secretion and insulin sensitivity and consequently in the development of NODAT
in kidney transplant recipients. Then, we further investigated the association between NODAT and single-
nucleotide polymorphisms of IRS-1 and IRS-2 in renal allograft recipients. One hundred and fifty-eight
kidney transplant patients, receiving tacrolimus as the base immunosuppressant, were divided into two
groups: with or without NODAT. Plasma levels of fasting insulin concentration (FINS) and C-peptide were
determined by enhanced chemiluminescence immunoassay and ADVIA Centaur C peptide assay,
respectively. The genotypes of Gly1057Asp in IRS-2 and Gly972Arg in IRS-1 were detected through
polymerase chain reaction fragment length polymorphism in NODAT and non-NODAT patients. It was
found that the concentrations of fasting plasma insulin and C-peptide in NODAT and non-NODAT patients
treated with tacrolimus were higher than that in healthy volunteers (p < 0.05). Fasting plasma insulin
concentration in NODAT was significantly elevated compared with than that in non-NODAT group (p <
0.05). But there are no statistical differences in fasting plasma C-peptide concentrations between NODAT
and non-NODAT groups. The allele and genotype frequencies of IRS-2 Gly1057Asp and IRS-1 Gly972Arg
in NODAT patients were not significantly different from non-NODAT patients (p > 0.05). In conclusion,
insulin resistance is the primary cause of tacrolimus-induced NODAT. The IRS-2 Gly1057Asp and IRS-1
Gly972Arg genotypes are not related to NODAT.
0 (Immunosuppressive Agents). 0 (Insulin). WM0HAQ4WNM (Tacrolimus).
Publication Type
Year of Publication
2015

<133>
Unique Identifier
25641399
Title
Antidiabetic therapy in post kidney transplantation diabetes mellitus. [Review]
Source
Transplantation Reviews. 29(3):145-53, 2015 Jul.
VI 1
Record Owner
Status
MEDLINE
Authors
Werzowa J; Saemann M; Haidinger M; Krebs M; Hecking M.
Authors Full Name
Werzowa, Johannes; Saemann, Marcus; Haidinger, Michael; Krebs, Michael; Hecking, Manfred.
Institution
Werzowa, Johannes. Department of Medicine 3, Division of Nephrology and Dialysis, Medical University
of Vienna, Austria. Electronic address: Johannes.werzowa@meduniwien.ac.at.
Saemann, Marcus. Department of Medicine 3, Division of Nephrology and Dialysis, Medical University
of Vienna, Austria.
Haidinger, Michael. Department of Medicine 3, Division of Nephrology and Dialysis, Medical University
of Vienna, Austria.
Page 51
Krebs, Michael. Department of Medicine 3, Division of Endocrinology and Metabolism, Medical
University of Vienna, Austria.
Hecking, Manfred. Department of Medicine 3, Division of Nephrology and Dialysis, Medical University
of Vienna, Austria.
*Diabetes Mellitus/dt [Drug Therapy]
Diabetes Mellitus/pp [Physiopathology]
Evidence-Based Medicine
Female
Follow-Up Studies
Humans
*Hypoglycemic Agents/tu [Therapeutic Use]
Male
Risk Assessment
Treatment Outcome
Abstract
Post-transplantation diabetes mellitus (PTDM) is a common complication after kidney transplantation that
affects up to 40% of kidney transplant recipients. By pathogenesis, PTDM is a diabetes form of its own,
and may be characterised by a sudden, drug-induced deficiency in insulin secretion rather than worsening
of insulin resistance over time. In the context of deteriorating allograft function leading to a re-occurrence
of chronic kidney disease after transplantation, pharmacological interventions in PTDM patients deserve
special attention. In the present review, we aim at presenting the current evidence regarding efficacy and
safety of the modern antidiabetic armamentarium. Specifically, we focus on incretin-based therapies and
insulin treatment, besides metformin and glitazones, and discuss their respective advantages and pitfalls.
Although recent pilot trials are available in both prediabetes and PTDM, further studies are warranted to
elucidate the ideal timing of various antidiabetics as well as its long-term impact on safety, glucose
metabolism and cardiovascular outcomes in kidney transplant recipients. Copyright © 2015 Elsevier Inc.
All rights reserved.
0 (Blood Glucose). 0 (Hypoglycemic Agents).
Publication Type
Journal Article. Research Support, Non-U.S. Gov't. Review.
Year of Publication
2015

<134>
Unique Identifier
25542907
Title
A longitudinal study of inflammation, CKD-mineral bone disorder, and carotid atherosclerosis after renal
transplantation.
Source
Clinical Journal of The American Society of Nephrology: CJASN. 10(3):471-9, 2015 Mar 06.
VI 1
Record Owner
Page 52
Status
MEDLINE
Authors
Yilmaz MI; Sonmez A; Saglam M; Cayci T; Kilic S; Unal HU; Karaman M; Cetinkaya H; Eyileten T;
Gok M; Oguz Y; Vural A; Mallamaci F; Zoccali C.
Authors Full Name
Yilmaz, Mahmut Ilker; Sonmez, Alper; Saglam, Mutlu; Cayci, Tuncer; Kilic, Selim; Unal, Hilmi Umut;
Karaman, Murat; Cetinkaya, Hakki; Eyileten, Tayfun; Gok, Mahmut; Oguz, Yusuf; Vural, Abdulgaffar;
Mallamaci, Francesca; Zoccali, Carmine.
Institution
Yilmaz, Mahmut Ilker. Departments of Nephrology, mahmutiyilmaz@yahoo.com.
Sonmez, Alper. Endocrinology.
Saglam, Mutlu. Radiology.
Cayci, Tuncer. Biochemistry, and.
Kilic, Selim. Epidemiology, Gulhane School of Medicine, Etlik-Ankara, Turkey; and.
Unal, Hilmi Umut. Departments of Nephrology.
Karaman, Murat. Departments of Nephrology.
Cetinkaya, Hakki. Departments of Nephrology.
Eyileten, Tayfun. Departments of Nephrology.
Gok, Mahmut. Departments of Nephrology.
Oguz, Yusuf. Departments of Nephrology.
Vural, Abdulgaffar. Departments of Nephrology.
Mallamaci, Francesca. Nephrology, Hypertension and Renal Transplantation and National Research
Council-Institute of Clinical Physiology Clinical Epidemiology of Renal Diseases and Hypertension,
Ospedali Riuniti, Reggio Calabria, Italy.
Zoccali, Carmine. National Research Council-Institute of Clinical Physiology Clinical Epidemiology of
Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy.
Adult
Blood Pressure
Bone Diseases, Metabolic/bl [Blood]
Bone Diseases, Metabolic/co [Complications]
*C-Reactive Protein/me [Metabolism]
Calcium/bl [Blood]
*Carotid Artery Diseases/bl [Blood]
Carotid Artery Diseases/co [Complications]
*Carotid Artery Diseases/dg [Diagnostic Imaging]
Carotid Intima-Media Thickness
Female
Fibroblast Growth Factors/bl [Blood]
Humans
Inflammation/bl [Blood]
Inflammation/co [Complications]
Insulin Resistance
*Kidney Failure, Chronic/bl [Blood]
Kidney Transplantation
Longitudinal Studies
Male
Parathyroid Hormone/bl [Blood]
Phosphates/bl [Blood]
Postoperative Period
Preoperative Period
Page 53
Young Adult
Keyword Heading
arteriosclerosis
chronic inflammation
renal transplantation
Abstract
BACKGROUND AND OBJECTIVES: The role of reversibility of nontraditional risk factors, like
inflammation and CKD-mineral bone disorder, in the reduction of cardiovascular risk after renal
transplantation is still scarcely defined.
DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The longitudinal relationship

between C-reactive protein, CKD-mineral bone disorder biomarkers, and intima media thickness was
investigated in a series of 178 patients (age=32+/-10 years) with stage 5 CKD maintained on chronic
dialysis who underwent echo-color Doppler studies of the carotid arteries before and after renal
transplantation. Smokers and patients with diabetes were excluded from the study. In all patients,
immunosuppression was performed by a standard regimen on the basis of calcineurin inhibitors. Healthy
controls were specifically selected to match the age and sex distribution of the patients. Biochemical and
intima media thickness assessments were repeated 6 months after transplantation.
RESULTS: Before transplantation, intima media thickness in patients with stage 5 CKD on dialysis
(average=0.9+/-0.2 mm) was higher (P<0.001) than in well matched healthy controls (0.6+/-0.1 mm) and
reduced substantially (-22%; 95% confidence interval, -24% to -20%) after transplantation (P=0.001). GFR
(multivariable-adjusted beta=0.23; P<0.001), C-reactive protein (beta=0.15; P<0.001), and fibroblast
growth factor 23 (beta=0.28; P<0.001) were the strongest independent correlates of intima media thickness
before transplantation. Similarly, longitudinal changes in the same biomarkers were the sole independent
correlates of simultaneous changes in intima media thickness (C-reactive protein: beta=0.25; fibroblast
growth factor 23: beta=0.26; P<0.001 for both) after renal transplantation. The evolution of intima media
thickness after transplantation was largely independent of classic risk factors, including BP, LDL
cholesterol, and insulin resistance, as measured by homeostatic model assessment.
CONCLUSIONS: Intima media thickness improves after renal transplantation. Such an improvement
associates with parallel changes in serum C-reactive protein and fibroblast growth factor 23. These
observations are in keeping with the hypothesis that the decline in cardiovascular risk after transplantation,
in part, depends on partial resolution of nontraditional cardiovascular risk factors, like inflammation and
CKD-mineral bone disorder. Copyright © 2015 by the American Society of Nephrology.
0 (Biomarkers). 0 (Parathyroid Hormone). 0 (Phosphates). 62031-54-3 (Fibroblast Growth Factors).
7Q7P4S7RRE (fibroblast growth factor 23). 9007-41-4 (C-Reactive Protein). SY7Q814VUP (Calcium).
Publication Type
Journal Article.
Year of Publication
2015

<135>
Unique Identifier
25207680
Title
Metabolic syndrome definitions and components in predicting major adverse cardiovascular events after
kidney transplantation.
Source
Page 54
Transplant International. 28(1):79-88, 2015 Jan.
VI 1
Record Owner
Status
MEDLINE
Authors
Prasad GV; Huang M; Silver SA; Al-Lawati AI; Rapi L; Nash MM; Zaltzman JS.
Authors Full Name
Prasad, G V Ramesh; Huang, Michael; Silver, Samuel A; Al-Lawati, Ali I; Rapi, Lindita; Nash, Michelle
M; Zaltzman, Jeffrey S.
Institution
Prasad, G V Ramesh. Division of Nephrology, Department of Medicine, University of Toronto, Toronto,
ON, Canada; Renal Transplant Program, St. Michael's Hospital, Toronto, ON, Canada.
Adolescent
Adult
Aged
*Cardiovascular Diseases/bl [Blood]
*Cardiovascular Diseases/co [Complications]
Cohort Studies
Diabetes Complications/th [Therapy]
*Dyslipidemias/bl [Blood]
Dyslipidemias/co [Complications]
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/mo [Mortality]
Male
*Metabolic Syndrome/di [Diagnosis]
Metabolic Syndrome/pp [Physiopathology]
Metabolic Syndrome/su [Surgery]
Middle Aged
Obesity/bl [Blood]
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Risk Factors
Treatment Outcome
Young Adult
Keyword Heading
cardiovascular disease
diabetes
dyslipidemia
microalbuminuria
obesity
Abstract
Metabolic syndrome (MetS) associates with cardiovascular risk post-kidney transplantation, but its
ambiguity impairs understanding of its diagnostic utility relative to components. We compared five MetS
definitions and the predictive value of constituent components of significant definitions for major adverse
cardiovascular events (MACE) in a cohort of 1182 kidney transplant recipients. MetS definitions were
Page 55
adjusted for noncomponent traditional Framingham risk factors and relevant transplant-related variables.
Kaplan-Meier, logistic regression, and Cox proportional hazards analysis were utilized. There were 143
MACE over 7447 patient-years of follow-up. Only the World Health Organization (WHO) 1998 definition
predicted MACE (25.3 vs 15.5 events/1000 patient-years, P = 0.019). Time-to-MACE was 5.5 +/- 3.5 years
with MetS and 6.8 +/- 3.9 years without MetS (P < 0.0001). MetS was independent of pertinent MACE risk
factors except age and previous cardiac disease. Among MetS components, dysglycemia provided greatest
hazard ratio (HR) for MACE (1.814 [95% confidence interval 1.26-2.60]), increased successively by
microalbuminuria (HR 1.946 [1.37-2.75]), dyslipidemia (3.284 [1.72-6.26]), hypertension (4.127 [2.16-
7.86]), and central obesity (4.282 [2.09-8.76]). MetS did not affect graft survival. In summary, although the
WHO 1998 definition provides greatest predictive value for post-transplant MACE, most of this is
conferred by dysglycemia and is overshadowed by age and previous cardiac disease. Copyright © 2014
Steunstichting ESOT.
Publication Type
Year of Publication
2015

<136>
Unique Identifier
24894384
Title
New-onset diabetes after kidney transplant in children. [Review]
Source
Pediatric Nephrology. 30(3):405-16, 2015 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Garro R; Warshaw B; Felner E.
Authors Full Name
Garro, Rouba; Warshaw, Barry; Felner, Eric.
Institution
Garro, Rouba. Department of Pediatrics, Division of Nephrology, Emory University, 2015 Uppergate
Drive NE, Atlanta, GA, 30322, USA, rouba.garro@emory.edu.
Child
Diabetes Mellitus/th [Therapy]
*Diabetes Mellitus
Humans
Incidence
Postoperative Complications/et [Etiology]
Page 56
*Postoperative Complications
Risk Factors
Abstract
The development of new-onset diabetes after kidney transplantation (NODAT) is associated with reduced
graft function, increased cardiovascular morbidity and lower patient survival among adult recipients. In the
pediatric population, however, the few studies examining NODAT have yielded inconsistent results.
Therefore, the true incidence of NODAT in the pediatric population has been difficult to establish. The
identification of children and adolescents at risk for NODAT requires appropriate screening questions and
tests pre- and post-kidney transplant. Several risk factors have been implicated in the pathogenesis of
NODAT and post-transplant glucose intolerance, including African American race, obesity, family history
of diabetes and the type of immunosuppressant regimen. Moreover, uremia per se results in a state of
insulin resistance that increases the risk of developing diabetes post-transplant. When an individual
becomes glucose intolerant, early lifestyle modification and antihyperglycemic measures with tailoring of
the immunosuppressant regimen should be implemented to prevent the development of NODAT. For the
child or adolescent with NODAT, antihyperglycemic therapy should be prescribed in order to achieve
optimal glycemic control, ultimately reducing complications and improving overall allograft and patient
survival. In this article, we review the risk factors, screening methods, diagnosis, management and outcome
of children and adolescents with NODAT and post-kidney transplant glucose intolerance.
Publication Type
Year of Publication
2015

<137>
Unique Identifier
25726205
Title
[Longitudinal study of the metabolic syndrome after kidney transplantation]. [Spanish]
Original Title
Estudio longitudinal del sindrome metabolico tras el trasplante renal.
Source
Nutricion Hospitalaria. 31(3):1142-6, 2014 Sep 12.
VI 1
Record Owner
Status
MEDLINE
Authors
Fernandez Castillo R; Fernandez Gallegos R; Zaragoza Fernandez GM.
Authors Full Name
Fernandez Castillo, Rafael; Fernandez Gallegos, Ruth; Zaragoza Fernandez, Gloria Maria.
Institution
Fernandez Castillo, Rafael. Universidad de Granada. Facultad de Ciencias de la Salud. Departamento de
Enfermeria.. rafaelfernandez@ugr.es.
Fernandez Gallegos, Ruth. Servicio de Nefrologia Unidad de Hemodialisis. Hospital Universitario Virgen
de las Nieves. Granada. Espana.. ruthfg@telefonica.net.
Zaragoza Fernandez, Gloria Maria. Servicio de Nefrologia Unidad de Hemodialisis. Hospital
Universitario Virgen de las Nieves. Granada. Espana.. falitos@gmail.com.
Adrenergic beta-Antagonists/tu [Therapeutic Use]
Page 57
Aged
Calcium Channel Blockers/tu [Therapeutic Use]
Disease Progression
Female
Graft Rejection/ep [Epidemiology]
Humans
Lipids/bl [Blood]
Male
Middle Aged
Prevalence
Risk Factors
Spain/ep [Epidemiology]
Abstract
BACKGROUND: The occurence of the metabolic syndrome (MS) between the renal receptors is one of
the major complications after transplantation and is associated with an increased risk of graft failure and
high rates of obesity and diabetes new appearance.
AIMS: This study aims to investigate the prevalence and risk factors associated with the development of
the MS and to evaluate the association between the same with the allograft dysfunction.
METHODS: The samples consisted of 138 renal transplant patients, 83 men and 55 women, kidney
transplant, which was attended by over five years for the transplant consultation. Were analyzed as
potential risk factors for MS: age, sex, body mass index (BMI), weight, hypertension, diabetes, LDL, HDL,
triglycerides in serum and immunosuppressive therapy (cyclosporine, tacrolimus, mycophenolate mofetil),
was also assessed the prevalence of acute rejection episodes and renal function.
RESULTS: The prevalence of MS was 39.85 %. As statistically significant risk factors were obtained the
BMI, overweight, HDL cholesterol levels, triglycerides and LDL as well as hypertension and diabetes.
There were high rates of acute rejection and differences in story to the glomerular filtration rate.
CONCLUSIONS: There is a high prevalence of the MS that severely compromised renal function and
graft survival in renal transplant patients, it is very important the control and strict monitoring of all risk
factors identified. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All
rights reserved.
Other Abstract
Publisher: Introduccion: La aparicion del sindrome metabolico (SM) entre los receptores renales es una de
la mayores complicaciones postrasplante y se asocia con un mayor riesgo de fracaso del injerto y altas tasas
de obesidad y diabetes de nueva aparicion. Objetivos: Este estudio tiene como objetivo investigar la
prevalencia y factores de riesgo asociados al desarrollo del SM y evaluar la asociacion del mismo con la
disfuncion del injerto. Metodos: La muestras estuvo formada por 138 pacientes trasplantados renales, 83
hombres y 55 mujeres, trasplantados renales, que asistieron durante cinco anos a la consulta postrasplante.
Se analizaron como posibles factores de riesgo para DMPT: edad, sexo, indice de masa corporal (IMC),
peso, hipertension, diabetes, LDL, HDL, trigliceridos en suero y terapia inmunosupresora (Ciclosporina,
tacrolimus, micofenolato mofetil), tambien se evaluo la prevalencia de episodios de rechazo agudo y
funcion renal. Resultados: La prevalencia de SM fue del 39,85%. Como factores de riesgo estadisticamente
significativos se obtuvieron el IMC, sobrepeso, niveles colesterol HDL, trigliceridos y LDL asi como la
hipertension y la diabetes. Se obtuvieron altas tasas de rechazo agudo y diferencias en cuento a la tasa de
filtracion glomerular. Conclusiones: Existe una alta prevalencia del SM que compromete gravemente la
Page 58
funcion renal y la supervivencia del injerto en pacientes trasplantados renales, Es importantisimo el control
y seguimiento estricto de todos los factores de riesgo identificados.; Language: Spanish
0 (Adrenergic beta-Antagonists). 0 (Calcium Channel Blockers). 0 (Immunosuppressive Agents). 0
(Lipids).
Publication Type
Journal Article.
Year of Publication
2014

<138>
Unique Identifier
25299197
Title
Decreased retinol-binding protein 4 in the sera of patients with end-stage renal disease after kidney
transplantation.
Source
Genetics & Molecular Research. 13(4):8126-34, 2014 Oct 07.
VI 1
Record Owner
Status
MEDLINE
Authors
Zhang WX; Zhou W; Zhang ZM; Zhang ZQ; He JF; Shi BY.
Authors Full Name
Zhang, W X; Zhou, W; Zhang, Z M; Zhang, Z Q; He, J F; Shi, B Y.
Institution
Zhang, W X. Department of Nephrology, PLA 309th Hospital, Beijing, China.
Zhou, W. Department of Nephrology, PLA 309th Hospital, Beijing, China.
Zhang, Z M. Department of Nephrology, PLA 309th Hospital, Beijing, China.
Zhang, Z Q. Department of Nephrology, PLA 309th Hospital, Beijing, China.
He, J F. Department of Laboratory Test, PLA 309th Hospital, Beijing, China.
Shi, B Y. PLA Institute of Transplantation, PLA 309th Hospital, Beijing, China bingyishi@yeah.net.
Adolescent
Adult
Female
Humans
Kidney Failure, Chronic/pp [Physiopathology]
Kidney Failure, Chronic/th [Therapy]
Male
Middle Aged
*Retinol-Binding Proteins, Plasma/me [Metabolism]
Young Adult
Page 59
Abstract
Retinol-binding protein 4 (RBP4) is a novel adipokine that has been associated with insulin resistance and
type 2 diabetes. Patients with end-stage renal disease (ESRD) have very high serum RBP4 levels. However,
whether successful kidney transplantation alleviates these elevated serum RBP4 levels is unclear. The
serum RBP4 levels of 24 ESRD patients were determined before transplantation and at 1 day, 1 week, and
1 month after kidney transplantation. The control group included 22 healthy subjects. Serum RBP4
concentrations were measured using a commercial kit via the immunologic turbidimetric method, and were
related to biomarkers for renal and liver function. The serum RBP4 level of ESRD patients before kidney
transplantation (160.8 +/- 29.1 mg/L) was approximately 7-fold higher than that of normal controls (22.6
+/- 11.0 mg/L; P = 0.000). The serum RBP4 level before transplantation was significantly higher than that
at 1 day (65.3 +/- 28.4 mg/L), 1 week (48.3 +/- 22.9 mg/L), and 1 month after transplantation (53.1 +/- 25.5
mg/L; P = 0.000). However, these values were still higher than those of controls (P = 0.000). Univariate
regression analysis showed that the percent changes in serum RBP4 concentration before and after kidney
transplantation were positively correlated with serum creatinine, blood urea nitrogen, phosphate, and pre-
albumin concentrations and negatively correlated with the estimated glomerular filtration rate. The serum
RBP4 concentration of patients with ESRD decreased significantly after kidney transplantation; therefore,
we found that serum RBP4 concentration was related to renal function.
0 (Biomarkers). 0 (RBP4 protein, human). 0 (Retinol-Binding Proteins, Plasma).
Publication Type
Journal Article.
Year of Publication
2014

<139>
Unique Identifier
25131130
Title
Prevalence of obesity and metabolic changes after kidney transplantation: Hungarian pediatric cohort
study.
Source
Transplantation Proceedings. 46(6):2160-3, 2014 Jul-Aug.
VI 1
Record Owner
Status
MEDLINE
Authors
Degi AA; Kis E; Kerti A; Cseprekal O; Szabo AJ; Reusz GS.
Authors Full Name
Degi, A A; Kis, E; Kerti, A; Cseprekal, O; Szabo, A J; Reusz, G S.
Institution
Degi, A A. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Kis, E. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Kerti, A. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Cseprekal, O. First Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
Szabo, A J. First Department of Pediatrics, Semmelweis University, Budapest, Hungary.
Reusz, G S. First Department of Pediatrics, Semmelweis University, Budapest, Hungary. Electronic
address: reusz.gyorgy@med.semmelweis-univ.hu.
Page 60
Adolescent
Body Mass Index
Female
Humans
Hungary/ep [Epidemiology]
Male
*Obesity/ep [Epidemiology]
Prevalence
Abstract
BACKGROUND: Cardiovascular mortality rate in patients with end-stage renal disease is 3 magnitudes
higher than in the general population; it remains 10-fold higher after successful renal transplantation (Tx).
Among others, obesity and hypertension can exert deleterious effects on vascular structure and function
after Tx. Successful kidney transplantation may induce excessive weight gain in part because of the effects
of steroid treatment.
METHODS: The purpose of this study was to evaluate the presence of obesity in Tx children, their
obesity-related metabolic disturbances, and to assess their blood pressure and arterial stiffness in relation to
obesity. Forty-one transplant children (age, 15.7 [3.5] years; 28 males) were studied. Body composition
was assessed by body mass index (BMI), waist circumference, skin-fold measurements, and multifrequence
bioimpedance analysis. Glucose metabolism, blood pressure, and arterial stiffness (with the use of pulse
wave velocity) were studied. Age- and sex-dependent parameters were expressed as standard deviation
scores (SDS).
RESULTS: The prevalence of overweight (BMI >85%) increased from 3.2% to 24.4% at 49 months (3-
183) (median, range); the BMI SDS increased from -0.27 (0.79) to 0.67 (1.35) after Tx. There was a close
correlation between BMI SDS and the percentage of body fat and body fat mass in the Tx group (r = 0.80; r
= 0.94, P = .0001). Children with disturbed glycemic control (n = 14) had higher percentage of body fat and
higher blood pressure compared with those with normal glucose metabolism (P < .05). There was no
difference in pulse wave velocity between the lean and obese patients.
CONCLUSIONS: The prevalence of overweight or obese patients in the Hungarian pediatric renal cohort
is low at transplantation and rises subsequently. Overweight is associated with disturbed glycemic control
and increased blood pressure; however, these disturbances are not yet reflected by stiffening of the arteries.
Strategies are needed to prevent obesity, its impact on hypertension, and cardiovascular disease in pediatric
transplantation. Copyright © 2014 Elsevier Inc. All rights reserved.
Publication Type
Year of Publication
2014

<140>
Unique Identifier
25131068
Title
Page 61
Portal versus systemic venous drainage of the pancreatic graft: the effect on glucose metabolism in
pancreas and kidney transplant recipients.
Source
Transplantation Proceedings. 46(6):1910-2, 2014 Jul-Aug.
VI 1
Record Owner
Status
MEDLINE
Authors
Havrdova T; Boucek P; Jedinakova T; Lipar K; Kocik M; Skibova J; Saudek F.
Authors Full Name
Havrdova, T; Boucek, P; Jedinakova, T; Lipar, K; Kocik, M; Skibova, J; Saudek, F.
Institution
Havrdova, T. Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Electronic address: teje@medicon.cz.
Boucek, P. Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Jedinakova, T. Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech
Republic.
Lipar, K. Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Kocik, M. Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Skibova, J. Statistical Department, Institute for Clinical and Experimental Medicine, Prague, Czech
Republic.
Saudek, F. Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
Adult
B-Lymphocytes, Regulatory/im [Immunology]
C-Peptide/bl [Blood]
*Diabetes Mellitus, Type 1/me [Metabolism]
Female
Glycated Hemoglobin A/an [Analysis]
Homeostasis
Humans
Insulin/bl [Blood]
Male
Middle Aged
Portal Vein
Abstract
Two different methods of graft venous drainage are used in pancreas transplantation: portal (PVD) and
systemic (SVD). PVD is considered to be more physiologic due to its similarity to venous outflow of the
native pancreas. The aim of our study was to compare glucose metabolism in Type 1 diabetic recipients of
kidney and pancreatic grafts with PVD versus SVD by intravenous glucose tolerance test (IVGTT). We
examined 28 insulin-independent patients after simultaneous pancreas and kidney transplantation: 14
recipients with PVD of the pancreatic graft and 14 with SVD after a mean post-transplant period of 1 year.
All recipients had stable good function of the kidney graft. Fasting glycemia, insulin levels, glycosylated
hemoglobin (HbA1c), and standard IVGTT with coefficient of glucose assimilation (KG) calculation were
assessed. Insulin sensitivity and production were evaluated using the homeostasis model assessment
(homeostasis model assessment of insulin resistance [HOMA-IR], homeostasis model assessment of B-cell
function [HOMA-B]). Total C-peptide and insulin secretions were calculated as areas under the curves
(AUCs) from the serum levels during the IVGTT. PVD and SVD groups did not differ in age, body mass
index (BMI) and duration of post-transplantation period (P >= .05). We did not find any significant
difference in fasting glycemia, HbA1c, KG, HOMA-IR, parameters of C-peptide level, fasting insulin level,
Page 62
and response during IVGTT. HOMA-B and AUC of insulin level were higher in the SVD group (45.1 +/-
35.1 versus 19.8 +/- 15.5, P =.03 and 1075 +/- 612 versus 1799 +/- 954 mIU/L/60 minutes, P < .03,
respectively). In the PVD group, 1 patient had an abnormal response to the glucose stimulus, 8 patients had
an impaired glucose tolerance, and 5 patients had a normal glucose tolerance. In the SVD group, an
abnormal response was present in none, impaired glucose tolerance in 4, and normal glucose tolerance in
10 recipients. Athough this was not a prospectively randomized trial, we conclude that the change of
surgical technique from SVD to PVD did not lead to any substantial change in terms of glucose tolerance.
0 (C-Peptide). 0 (Glycated Hemoglobin A). 0 (Insulin). 0 (hemoglobin A1c protein, human).
IY9XDZ35W2 (Glucose).
Publication Type
Year of Publication
2014

<141>
Unique Identifier
25112485
Title
The relationship between daily urinary sodium excretion and metabolic syndrome in patients with kidney
transplantation.
Source
Annals of Transplantation. 19:397-402, 2014 Aug 12.
VI 1
Record Owner
Status
MEDLINE
Authors
Unal A; Kocyigit I; Sipahioglu MH; Tokgoz B; Oymak O.
Authors Full Name
Unal, Aydin; Kocyigit, Ismail; Sipahioglu, Murat Hahri; Tokgoz, Bulent; Oymak, Oktay.
Institution
Unal, Aydin. Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
Kocyigit, Ismail. Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
Sipahioglu, Murat Hahri. Department of Nephrology, Erciyes University Medical School, Kayseri,
Turkey.
Tokgoz, Bulent. Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
Oymak, Oktay. Department of Nephrology, Erciyes University Medical School, Kayseri, Turkey.
Adult
Blood Pressure
Creatinine/me [Metabolism]
Female
Humans
Male
Page 63
*Metabolic Syndrome/ur [Urine]
Middle Aged
Risk Factors
*Sodium/ur [Urine]
Sodium Chloride, Dietary/ad [Administration & Dosage]
Turkey
Abstract
BACKGROUND: The aim of this study was to determine whether there is a relationship between daily
urinary sodium excretion and metabolic syndrome in kidney transplantation patients.
MATERIAL AND METHODS: This cross-sectional study included 76 adult renal transplantation
recipients. To calculate urinary sodium excretion, 24-h urine samples were collected. Metabolic syndrome
was diagnosed according to Adult Treatment Panel III (ATP III) criteria updated in a statement from the
American Heart Association (AHA)/National Heart, Lung, and Blood Institute (NHLBI) in 2005.
RESULTS: Mean age of the 76 patients was 38 +/- 10 years; 21 of the 76 patients were female. Metabolic
syndrome was found in 52 (68.4%) of the 76 renal transplantation patients. Mean daily urinary sodium
excretion was 190 +/- 102 mmol/day, which is equal to a salt intake of 11.1 g/day. Daily urinary sodium
excretion was significantly higher in patients with metabolic syndrome compared to those without
metabolic syndrome (209 +/- 112 mmol/day and 150 +/- 62 mmol/day, respectively, p: 0.005). Daily
urinary sodium excretion correlated with diastolic blood pressure (r: 0.254, p: 0.028), serum glucose
concentration (r: 0.446, p: <0.001), and creatinine clearance (r: 478, p: <0.001). In addition, although there
was no significant correlation between daily urinary sodium excretion and systolic blood pressure, the
statistical significance was borderline (r: 0.221, p: 0.056).
CONCLUSIONS: There is a significant relationship between daily urinary sodium excretion and
metabolic syndrome in renal transplant recipients. The Turkish kidney transplantation patients consume a
great amount of salt and salt intake is positively correlated with blood pressure.
0 (Sodium Chloride, Dietary). 9NEZ333N27 (Sodium). AYI8EX34EU (Creatinine).
Publication Type
Journal Article.
Year of Publication
2014

<142>
Unique Identifier
25049200
Title
Adiponectin receptor and adiponectin signaling in human tissue among patients with end-stage renal
disease.
Source
Nephrology Dialysis Transplantation. 29(12):2268-77, 2014 Dec.
VI 1
Record Owner
Status
MEDLINE
Authors
Page 64
Martinez Cantarin MP; Keith SW; Waldman SA; Falkner B.
Authors Full Name
Martinez Cantarin, Maria P; Keith, Scott W; Waldman, Scott A; Falkner, Bonita.
Institution
Martinez Cantarin, Maria P. Division of Nephrology, Department of Medicine, Thomas Jefferson
University Hospital, Philadelphia, PA, USA.
Keith, Scott W. Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson
University, Philadelphia, PA, USA.
Waldman, Scott A. Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson
University, Philadelphia, PA, USA.
Falkner, Bonita. Division of Nephrology, Department of Medicine, Thomas Jefferson University
Hospital, Philadelphia, PA, USA.
Acetyl-CoA Carboxylase/ge [Genetics]
Adiponectin/bi [Biosynthesis]
*Adiponectin/ge [Genetics]
Adult
Cells, Cultured
Female
Follow-Up Studies
Humans
Immunohistochemistry
*Intra-Abdominal Fat/me [Metabolism]
*Kidney Failure, Chronic/ge [Genetics]
Kidney Failure, Chronic/me [Metabolism]
Kidney Failure, Chronic/pa [Pathology]
Male
Middle Aged
Phosphorylation
*RNA/ge [Genetics]
Real-Time Polymerase Chain Reaction
Receptors, Adiponectin/bi [Biosynthesis]
*Receptors, Adiponectin/ge [Genetics]
Signal Transduction
*Up-Regulation
Keyword Heading
ESRD
adiponectin
cell signaling
inflammation
Abstract
BACKGROUND: Adiponectin plasma levels in chronic kidney disease (CKD) are two to three times
higher than in individuals with normal kidney function. Despite adiponectin's anti-diabetic, anti-
inflammatory and anti-atherogenic properties, patients with CKD have insulin resistance, systemic
inflammation and accelerated atherogenesis. Hence, although adiponectin production is increased by
adipose tissue in end-stage renal disease (ESRD), it is unclear if its effects on metabolism remain intact.
METHODS: To determine if there is adiponectin resistance in ESRD, we measured tissue levels of

adiponectin receptor-1 (AdipoR1) and adiponectin downstream effectors in ESRD patients compared with
normal kidney function controls. Blood and tissue samples were obtained from participants at the time of
kidney transplantation or kidney donation. A follow-up blood sample was obtained 3-6 months after
transplantation.
RESULTS: AdipoR1 was higher in muscle and peripheral blood mononuclear cells collected from ESRD
patients. There was also a nonsignificant increase in AdipoR1 in visceral fat of ESRD compared with
Page 65
controls. Compared with controls, phosphorylation of the adiponectin downstream effector adenosine
monophosphate-activated protein kinase (AMPK) was higher in ESRD while acetyl-CoA carboxylase
phosphorylation (ACC-P) and carnitine palmitoyl transferase-1 (CPT-1) levels were lower. In vitro,
exposure of C2C12 cells to uremic serum resulted in upregulation of AdipoR1 and increased
phosphorylation of AMPK but decreased ACC-P and CPT-1 expression.
CONCLUSION: Both our in vivo and in vitro observations indicate that uremia results in upregulation of
AdipoR1 but adiponectin resistance at the post-receptor level. Copyright © The Author 2014. Published by
Oxford University Press on behalf of ERA-EDTA. All rights reserved.
0 (ADIPOR1 protein, human). 0 (Adiponectin). 0 (Receptors, Adiponectin). 63231-63-0 (RNA). EC 6-4-
1-2 (Acetyl-CoA Carboxylase).
Publication Type
Journal Article. Research Support, N.I.H., Extramural. Research Support, Non-U.S. Gov't.
Year of Publication
2014

<143>
Unique Identifier
25017084
Title
Immunosuppression: trends and tolerance?. [Review]
Source
Clinics in Liver Disease. 18(3):687-716, 2014 Aug.
VI 1
Record Owner
Status
MEDLINE
Authors
Porrett PM; Hashmi SK; Shaked A.
Authors Full Name
Porrett, Paige M; Hashmi, Sohaib K; Shaked, Abraham.
Institution
Porrett, Paige M. Division of Liver Transplantation, Department of Surgery, The University of
Pennsylvania, 3400 Spruce Street, One Founders Pavilion, Philadelphia, PA 19104, USA.
Hashmi, Sohaib K. Department of Surgery, The University of Pennsylvania, 3400 Spruce Street, Two
Dulles Pavilion, Philadelphia, PA 19104, USA.
Shaked, Abraham. Division of Liver Transplantation, Department of Surgery, Penn Transplant Institute,
The University of Pennsylvania, 3400 Spruce Street, Two Dulles Pavilion, Philadelphia, PA 19104, USA.
Electronic address: abraham.shaked@uphs.upenn.edu.
Adult
Animals
Child
Clinical Trials as Topic
Female
Hepatitis C, Chronic/su [Surgery]
Humans
Immunosuppression/mt [Methods]
Page 66
*Immunosuppression/td [Trends]
Immunosuppressive Agents/ad [Administration & Dosage]
Infection/et [Etiology]
Kidney Failure, Chronic/ci [Chemically Induced]
Kidney Failure, Chronic/pc [Prevention & Control]
Liver Transplantation/mt [Methods]
*Liver Transplantation/td [Trends]
Male
Metabolic Syndrome/ci [Chemically Induced]
Metabolic Syndrome/pc [Prevention & Control]
Models, Immunological
Neoplasms/et [Etiology]
Neoplasms/pc [Prevention & Control]
Precision Medicine
Recurrence
Transplantation Tolerance/de [Drug Effects]
Transplantation Tolerance/im [Immunology]
Keyword Heading
Biomarkers
Immunosuppression
Minimization
Tolerance
Abstract
Advances in pharmacologic immunosuppression are responsible for the excellent outcomes experienced
by recipients of liver transplants. However, long-term follow-up of these patients reveals an increasing
burden of morbidity and mortality that is attributable to these drugs. The authors summarize the agents used
in contemporary liver transplantation immunosuppression protocols and discuss the emerging trend within
the community to minimize or eliminate these agents from use. The authors present recently published data
that may provide the foundation for immunosuppression minimization or tolerance induction in the future
and review studies that have focused on the utility of biomarkers in guiding immunosuppression
management. Copyright © 2014 Elsevier Inc. All rights reserved.
Publication Type
Year of Publication
2014

<144>
Unique Identifier
24992735
Title
[Metabolic syndrome after kidney transplantation-editorial]. [Czech]
Original Title
Metabolicky syndrom po transplantaci ledviny-editorial.
Source
Vnitrni Lekarstvi. 60(3):187-8, 2014 Mar.
Page 67
VI 1
Record Owner
Status
MEDLINE
Authors
Teplan V.
Authors Full Name
Teplan, Vladimir.
Comments
Comment on (CON)
Female
Humans
Male
Publication Type
Editorial. Comment.
Year of Publication
2014

<145>
Unique Identifier
24984885
Title
Posttransplantation normoglycemic diabetic nephropathy: the role of the allograft insulin resistance--a
case report.
Source
Transplantation Proceedings. 46(7):2381-5, 2014 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Filippone EJ; Abubacker F; Farber JL.
Authors Full Name
Filippone, E J; Abubacker, F; Farber, J L.
Institution
Filippone, E J. Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital,
Philadelphia, Pennsylvania. Electronic address: kidneys@comcast.net.
Abubacker, F. Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital,
Philadelphia, Pennsylvania.
Farber, J L. Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Adult
Allografts
*Diabetic Nephropathies/pp [Physiopathology]
Female
Page 68
Humans
*Insulin Resistance
Insulin-Secreting Cells
Lupus Nephritis/su [Surgery]
Podocytes/ph [Physiology]
Abstract
BACKGROUND: The pathogenesis of diabetic nephropathy is incompletely understood. Although the
role of hyperglycemia is well-established, the participation of insulin resistance is increasingly appreciated.
Podocytes are insulin responsive cells and require normal insulin signaling for sustained viability.
CASE REPORT: We have presented a renal transplant recipient with lupus nephritis who received a
deceased donor kidney from a patient with diabetes mellitus (DM). The kidney functioned well initially.
Within 2 years, however, nephrotic range proteinuria developed, and a biopsy revealed diabetic
nephropathy that had clearly evolved in comparison with the implantation biopsy. The recipient was
repeatedly normoglycemic with normal glycated hemoglobin and glucose tolerance, and she was found to
be quite insulin sensitive on the basis of a low homeostasis model assessment of insulin resistance.
CONCLUSIONS: We argue that the nephropathy developed in the allograft owing to impaired insulin
signaling from intrinsic donor-derived insulin resistance that was exacerbated by low insulin levels in the
insulin-sensitive recipient. This case has implications for the most appropriate utilization of kidneys from
donors with DM. Copyright © 2014 Elsevier Inc. All rights reserved.
Publication Type
Case Reports. Journal Article.
Year of Publication
2014

<146>
Unique Identifier
24981694
Title
[Metabolic syndrome after kidney transplantation]. [Czech]
Original Title
Metabolicky syndrom po transplantaci ledviny.
Source
Vnitrni Lekarstvi. 60(3):196-204, 2014 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Nedbalkova M; Svojanovsky J; Trnavsky K; Kuman M; Jarkovsky J; Karpisek M; Soucek M.
Authors Full Name
Nedbalkova, Marta; Svojanovsky, Jan; Trnavsky, Karel; Kuman, Milan; Jarkovsky, Jiri; Karpisek,
Michal; Soucek, Miroslav.
Comments
Comment in (CIN)
Page 69
Adult
Age Factors
Aged
Czech Republic/ep [Epidemiology]
Female
Humans
Male
Middle Aged
Keyword Heading
abdominal obesity - albuminuria - allograft dysfunction - dyslipidaemia - kidney transplantation -
metabolic syndrome - new-onset diabetes mellitus after transplantation.
Abstract
INTRODUCTION: Metabolic syndrome is a risk factor for cardiovascular diseases. Higher risk of the
metabolic syndrome and its components in patients after kidney transplantation is caused by
immunosuppressive therapy. THE AIM OF OUR STUDY was to evaluate the prevalence of the metabolic
syndrome and its components in kidney transplant recipients and to analyse their influence on allograft
function and albuminuria.
PATIENTS, METHOD AND RESULTS: In the study we monitored 69 patients after cadaveric kidney
transplantation. The prevalence of the meta-bolic syndrome was 61.3 % 3 years after kidney
transplantation. The prevalence of new onset diabetes mellitus after transplantation was 27 % and that of
abdominal obesity 59.7 % of patients. The age of kidney transplant recipients with the metabolic syndrome
was higher than of these without it, but not statistically significant. The age of kidney transplant recipients
with new onset diabetes mellitus after transplantation was significantly higher, 54.0 (35.0; 69.0) years, than
in patients without it, 45.5 (27.0; 60.0) years, OR (95% IS) 1.116 (1.031; 1.207), p = 0.006.The number of
components of the metabolic syndrome was negatively correlated with the graft function (rs -0,275, p =
0,031). In patients with impaired renal function with estimated glomerular filtration (using MDRD
equation) < 1 ml/s 3 years after kidney transplantation the prevalence of the metabolic syndrome and
hypertriglyceridaemia was significantly higher. Chronic allograft dysfunction was predicted by donor age,
delayed allograft function, rejection, low level of HDL-cholesterol, hypertriglyceridaemia and
hyperuricaemia. Hyperuricaemia was the only significant predictor of allograft dysfunction independently
of the presence of delayed allograft function, rejection episodes and donor age. The metabolic syndrome,
elevation of apolipoprotein B and nonHDL-cholesterol and increased systolic blood pressure were
associated with albuminuria. Higher levels of apolipoprotein B and total cholesterol were independent
predictors of increased albumin-creatinine ratio. Obesity had no impact on graft function nor on
albuminuria, the influence of the new onset diabetes mellitus after transplantation was not significant
independently on other factors. We confirmed the correlation of the presence of the metabolic syndrome
with increased levels of AFABP (adipocyte fatty acid-binding protein) and leptin. Increased level of
AFABP predicted allograft dysfunction 3 years after kidney transplantation.
CONCLUSION: The influence of imunosuppressive treatment on new onset diabetes mellitus after
transplantation is well documented. However, we conclude that age is an important additional risk factor
for the development of diabetes mellitus in kidney transplant recipients group and it is recommended to
follow mainly older patients. Early detection of metabolic abnormalities and dietary and therapeutic
intervention in kidney transplant recipients may help to prevent chronic allograft dysfunction.
Publication Type
Journal Article.
Year of Publication
2014
Page 70
<147>
Unique Identifier
24975051
Title
New-onset diabetes after renal transplantation. [Review]
Source
Diabetic Medicine. 31(11):1284-92, 2014 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Tufton N; Ahmad S; Rolfe C; Rajkariar R; Byrne C; Chowdhury TA.
Authors Full Name
Tufton, N; Ahmad, S; Rolfe, C; Rajkariar, R; Byrne, C; Chowdhury, T A.
Institution
Tufton, N. Department of Diabetes and Metabolism, Barts and the London School of Medicine and
Dentistry, London, UK.
Animals
*Diabetes Mellitus, Type 2/ep [Epidemiology]
Diabetes Mellitus, Type 2/et [Etiology]
Diabetes Mellitus, Type 2/pc [Prevention & Control]
Diabetes Mellitus, Type 2/th [Therapy]
Humans
Postoperative Complications/pc [Prevention & Control]
Risk Factors
Abstract
Renal transplantation has important benefits in people with end-stage renal disease, with improvements in
mortality, morbidity and quality of life. Whilst significant advances in transplantation techniques and
immunosuppressive regimens have led to improvements in short-term outcomes, longer-term outcomes
have not improved dramatically. New-onset diabetes after transplantation appears to be a major factor in
morbidity and cardiovascular mortality in renal transplant recipients. The diagnosis of new-onset diabetes
after renal transplantation has been hampered by a lack of clarity over diagnostic tests in early studies,
although the use of the WHO criteria is now generally accepted. HbA1c may be useful diagnostically, but
should probably be avoided in the first 3 months after transplantation. The pathogenesis of new-onset
diabetes after renal transplantation is likely to be related to standard pathogenic factors in Type 2 diabetes
(e.g. insulin resistance, beta-cell failure, inflammation and genetic factors) as well as other factors, such as
hepatitis C infection, and could be exacerbated by the use of immunosuppression (glucocorticoids and
calcineurin inhibitors). Pre-transplant risk scores may help identify those people at risk of new-onset
diabetes after renal transplantation. There are no randomized trials of treatment of new-onset diabetes after
renal transplantation to determine whether intensive glucose control has an impact on cardiovascular or
renal morbidity, therefore, treatment is guided by guidelines used in non-transplant diabetes. Many areas of
uncertainty in the pathogenesis, diagnosis and management of new-onset diabetes after renal
transplantation require further research. Copyright © 2014 The Authors. Diabetic Medicine © 2014
Diabetes UK.
Publication Type
Page 71
Year of Publication
2014

<148>
Unique Identifier
24931259
Title
Effects of tacrolimus and cyclosporine treatment on metabolic syndrome and cardiovascular risk factors
after renal transplantation: a meta-analysis.
Source
Chinese Medical Journal. 127(12):2376-81, 2014.
VI 1
Record Owner
Status
MEDLINE
Authors
Xue W; Zhang Q; Xu Y; Wang W; Zhang X; Hu X.
Authors Full Name
Xue, Wenrui; Zhang, Qiang; Xu, Yue; Wang, Wei; Zhang, Xiaodong; Hu, Xiaopeng.
Institution
Xue, Wenrui. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
100020, China.
Zhang, Qiang. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
100020, China.
Xu, Yue. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
100020, China.
Wang, Wei. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
100020, China.
Zhang, Xiaodong. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University,
Beijing 100020, China.
Hu, Xiaopeng. Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing
100020, China.
Calcineurin/tu [Therapeutic Use]
*Cardiovascular Diseases/dt [Drug Therapy]
*Cyclosporine/tu [Therapeutic Use]
Humans
Hyperlipidemias/dt [Drug Therapy]
Hypertension/dt [Drug Therapy]
*Metabolic Syndrome/dt [Drug Therapy]
Randomized Controlled Trials as Topic
*Tacrolimus/tu [Therapeutic Use]
Abstract
BACKGROUND: The therapeutic success of renal transplantation has been largely attributable to the
development of effective and balanced immunosuppressive treatment regimens. This study provides a
meta-analysis of a series of randomized controlled trials that compared the effects of tacrolimus and
cyclosporine on metabolic syndrome (MetS) and cardiovascular risk factors after renal transplantation.
Page 72
METHODS: We searched various electronic databases and bibliographies, including MEDLINE, the
Cochrane Central Register of Controlled Trials, and EMBASE, for relevant studies published prior to
October 2012.
RESULTS: Our meta-analysis included five randomized controlled trials that examined a total of 923
patients. The tacrolimus group and the cyclosporine group exhibited no significant differences in MetS
incidence after renal transplantation; risk ratio (RR): 1.06, 95% confidence interval (CI): 0.73-1.55, P =
0.76. Cyclosporine treatment was associated with a higher incidence of hyperlipidemia (RR: 0.50, 95% CI:
0.39-0.64, P < 0.01). Although there were no statistically significant differences, cyclosporine treatment
was associated with a higher incidence of hypertension (RR: 0.91, 95% CI: 0.83-1.00, P = 0.06) after renal
transplantation compared to tacrolimus treatment, and tacrolimus treatment was associated with a higher
incidence of diabetes after renal transplantation (RR: 1.79, 95% CI: 0.98-3.27, P = 0.06) compared to
cyclosporine treatment.
CONCLUSIONS: Compared to tacrolimus treatment, cyclosporine treatment was associated with a

higher incidence of hyperlipidemia. Future large-scale studies are expected to be conducted to further
confirm our findings.
83HN0GTJ6D (Cyclosporine). EC 3-1-3-16 (Calcineurin). WM0HAQ4WNM (Tacrolimus).
Publication Type
Journal Article. Meta-Analysis. Research Support, Non-U.S. Gov't.
Year of Publication
2014

<149>
Unique Identifier
24909487
Title
The effect of magnesium supplements on early post-transplantation glucose metabolism: a randomized
controlled trial.
Source
Transplant International. 27(9):895-902, 2014 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Van Laecke S; Nagler EV; Taes Y; Van Biesen W; Peeters P; Vanholder R.
Authors Full Name
Van Laecke, Steven; Nagler, Evi Vanessa; Taes, Youri; Van Biesen, Wim; Peeters, Patrick; Vanholder,
Raymond.
Institution
Van Laecke, Steven. Renal Division, Ghent University Hospital, Ghent, Belgium.
Comments
Comment in (CIN)
Adult
Aged
Page 73
Area Under Curve
Calcineurin Inhibitors/ae [Adverse Effects]
Calcineurin Inhibitors/bl [Blood]
Calcineurin Inhibitors/tu [Therapeutic Use]
*Diabetes Mellitus, Type 2/pc [Prevention & Control]
Diarrhea/ci [Chemically Induced]
Female
Graft vs Host Disease/pc [Prevention & Control]
Humans
Insulin Resistance/ph [Physiology]
*Insulin Resistance
Magnesium/ph [Physiology]
*Magnesium Deficiency/dt [Drug Therapy]
Magnesium Deficiency/et [Etiology]
Magnesium Oxide/ad [Administration & Dosage]
Magnesium Oxide/ae [Adverse Effects]
*Magnesium Oxide/tu [Therapeutic Use]
Male
Middle Aged
*Postoperative Complications/dt [Drug Therapy]
Postoperative Complications/pc [Prevention & Control]
*Prediabetic State/bl [Blood]
Receptor, Insulin/ph [Physiology]
Severity of Illness Index
Tacrolimus/ae [Adverse Effects]
Tacrolimus/bl [Blood]
Tacrolimus/tu [Therapeutic Use]
Keyword Heading
glucose
magnesium
randomized controlled trial
Abstract
Post-transplantation hypomagnesemia is common and predicts diabetes. Magnesium improves glycemic
control in diabetics and insulin sensitivity in insulin resistant subjects. We aimed to assess the effectiveness
of oral magnesium for improving glycemic control and insulin sensitivity at 3 months post-transplantation.
We conducted a single-center, open-label, randomized parallel group study. We included adults with serum
magnesium <1.7 mg/dl within 2 weeks after kidney transplantation. We randomized participants to 450 mg
magnesium oxide up to three times daily or no treatment. The primary endpoint was the mean difference in
fasting glycemia. Secondary endpoints were the mean difference in area under the curve (AUC) of glucose
during an oral glucose tolerance test and insulin resistance measured by Homeostasis Model of
Assessment-Insulin Resistance (HOMA-IR). Analyses were on intention-to-treat basis. In patients
randomized to magnesium oxide (N = 27) versus no treatment (N = 27), fasting glycemia on average was
11.5 mg/dl lower (95% CI 1.7 to 21.3; P = 0.02). There was no difference between the two groups neither
for 2 h AUC, where the mean value was 1164 mg/dl/min (95% CI -1884 to 4284; P = 0.45) lower in the
treatment group nor for HOMA-IR. Magnesium supplements modestly improved fasting glycemia without
effect on insulin resistance. Higher baseline glycemia among patients in the control group may have driven
the positive outcome (ClinicalTrials.gov number: NCT01889576). Copyright © 2014 Steunstichting ESOT.
Page 74
0 (Blood Glucose). 0 (Calcineurin Inhibitors). 3A3U0GI71G (Magnesium Oxide). EC 2-7-10-1 (Receptor,
Insulin). I38ZP9992A (Magnesium). WM0HAQ4WNM (Tacrolimus).
Publication Type
Comparative Study. Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Year of Publication
2014

<150>
Unique Identifier
24852433
Title
Addressing uncertainties in renal transplantation: hypomagnesemia and the case of diabetes prevention.
[Review]
Source
Transplant International. 27(9):892-4, 2014 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Werzowa JM; Saemann MD.
Authors Full Name
Werzowa, Johannes M; Saemann, Marcus D.
Institution
Werzowa, Johannes M. Clinical Division of Nephrology, Internal Medicine III, Medical University of
Vienna, Vienna, Austria.
Comments
Comment on (CON)
Female
Humans
*Insulin Resistance
*Magnesium Deficiency/dt [Drug Therapy]
*Magnesium Oxide/tu [Therapeutic Use]
Male
*Postoperative Complications/dt [Drug Therapy]
*Prediabetic State/bl [Blood]
3A3U0GI71G (Magnesium Oxide).
Publication Type
Journal Article. Review. Comment.
Year of Publication
2014

Page 75
<151>
Unique Identifier
24811303
Title
Elevated resistin levels are associated with inflammation in hemodialysis patients with failed renal
allografts.
Source
International Journal of Artificial Organs. 37(5):358-63, 2014 May.
VI 1
Record Owner
Status
MEDLINE
Authors
Akagun T; Caliskan Y; Yazici H; Ozkok A; Telci A; Turkmen A; Yildiz A; Sever MS.
Authors Full Name
Akagun, Tulin; Caliskan, Yasar; Yazici, Halil; Ozkok, Abdullah; Telci, Aysegul; Turkmen, Aydin; Yildiz,
Alaattin; Sever, Mehmet Sukru.
Institution
Akagun, Tulin. 1 Division of Nephrology, Department of Internal Medicine, Istanbul Faculty of Medicine,
Istanbul University, Istanbul - Turkey.
Female
Humans
*Inflammation/bl [Blood]
Interleukin-6/bl [Blood]
Male
Middle Aged
Renal Dialysis
*Resistin/bl [Blood]
Treatment Failure
Tumor Necrosis Factor-alpha/bl [Blood]
Abstract
BACKGROUND: Resistin is an adipocytokine, associated with insulin resistance and inflammation. The
aim of this study is to evaluate the levels of serum resistin levels and other markers of inflammation in
hemodialysis (HD) patients with failed renal allografts.
METHODS: Sixty-nine HD patients with failed renal allografts and 98 never transplanted (naive) HD
patients and also 21 healthy controls were included in the study. Serum levels of various biochemical
parameters as well as resistin, IL-6, TNF-alpha and hs-CRP as biochemical markers of inflammation, were
measured.
RESULTS: Serum resistin levels in patients with failed renal allografts (4.80 +/- 2.06 ng/mL) were
significantly higher than those of the naive HD patients (3.44 +/- 1.48 ng/mL) and healthy controls (0.95
+/- 0.38 ng/mL; p<0.001). Patients with failed transplants were also characterized by higher TNF-alpha
levels (96.8 +/- 131.3 pg/mL vs. 40.9 +/- 25.4 pg/mL; p<0.001) and IL-6 levels (83.9 +/- 150.9 pg/mL vs.
14.6 +/- 14.4 pg/mL; p<0.001) as compared to naive HD patients. Serum hs-CRP levels in patients with
failed renal allografts (9.33 +/- 11.86 mg/L) were significantly higher than those of the naive HD patients
(1.26 +/- 1.71 mg/L) and healthy controls (2.12 +/- 1.82 mg/L; p<0.001). Serum albumin levels in patients
Page 76
with failed transplants (3.84 +/- 0.47 g/dL) were lower as compared to never transplanted HD patients (4.13
+/- 0.33 g/dL) and healthy controls (4.53 +/- 0.40 g/dL; p<0.001). There was a positive correlation between
serum resistin and TNF-alpha levels (r = 0.486, p<0.001).
CONCLUSIONS: Serum resistin levels are increased in HD patients with failed renal allografts very
probably reflecting an allograft-induced chronic inflammatory state.
0 (Biomarkers). 0 (Interleukin-6). 0 (Resistin). 0 (Tumor Necrosis Factor-alpha).
Publication Type
Year of Publication
2014

<152>
Unique Identifier
24767391
Title
Three-dimensional computed tomographic volumetric changes in pancreas before and after living donor
surgery for pancreas transplantation: effect of volume on glucose metabolism.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Otsuki K; Akutsu N; Maruyama M; Saigo K; Hasegawa M; Aoyama H; Matsumoto I; Asano T; Ito T;
Kenmochi T.
Authors Full Name
Otsuki, K; Akutsu, N; Maruyama, M; Saigo, K; Hasegawa, M; Aoyama, H; Matsumoto, I; Asano, T; Ito,
T; Kenmochi, T.
Institution
Otsuki, K. Department of Surgery, Chiba-East National Hospital, Chiba, Japan. Electronic address:
otsuki@cehpnet.com.
Akutsu, N. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Maruyama, M. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Saigo, K. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Hasegawa, M. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Aoyama, H. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Matsumoto, I. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Asano, T. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Ito, T. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Kenmochi, T. Department of Surgery, Chiba-East National Hospital, Chiba, Japan.
Adult
Aged
Female
Page 77
Humans
*Living Donors
Male
Middle Aged
Organ Size
*Pancreas/dg [Diagnostic Imaging]
*Tomography, X-Ray Computed/mt [Methods]
Abstract
In the present study, we aimed to compare the pancreas volumetric changes before and after living donor
surgery for pancreas transplantation, using three-dimensional (3D) computed tomography (CT) and glucose
metabolism. Pancreatic volume (PV) measurement using 3D CT was performed in 13 consecutive donors
who underwent distal pancreatectomy for simultaneous living donor pancreas and kidney transplantation.
PV was measured using a workstation before and 3 months after living donor operation. As the parameters
of glucose metabolism, hemoglobin A1c (HbA1c) level, fasting plasma glucose (FPG) level, body mass
index (BMI), homeostasis model assessment of insulin resistance (HOMA-IR), and insulinogenic index
(IGI) were examined simultaneously with the PV measurement. The preoperative and postoperative PVs of
pancreas was 30 +/- 5 mL and 42 +/- 9 mL, respectively. The postoperative PV was significantly higher
than the preoperative PV (P < .01) and increased by approximately 40% at 3 months after surgery. The
postoperative FPG and HbA1c levels were significantly higher than the preoperative values (P < .01). BMI
decreased significantly after surgery (P < .01). No differences in HOMA-IR and IGI were noted between
before and after surgery. Diabetes mellitus was not observed any of the 13 living donors during this period.
Distal pancreatectomy for living donors caused an increase in the PV and maintained insulin resistance, but
it was not sufficient to maintain glucose metabolism at the preoperative state. Copyright © 2014 Elsevier
Inc. All rights reserved.
0 (Blood Glucose). 0 (Glycated Hemoglobin A). 0 (hemoglobin A1c protein, human).
Publication Type
Journal Article.
Year of Publication
2014

<153>
Unique Identifier
24656008
Title
Challenges for preventing the metabolic syndrome in kidney transplant recipients, initial report: survey of
the current state of affairs before acting.
Source
Transplantation Proceedings. 46(2):543-5, 2014.
VI 1
Record Owner
Status
MEDLINE
Authors
Nakanome M; Sasaki H; Yazawa M; Imai N; Kawarazaki H; Shibagaki Y; Kimura K; Saito Y; Sakurai Y;
Chikaraishi T.
Authors Full Name
Page 78
Nakanome, M; Sasaki, H; Yazawa, M; Imai, N; Kawarazaki, H; Shibagaki, Y; Kimura, K; Saito, Y;
Sakurai, Y; Chikaraishi, T.
Institution
Nakanome, M. Department of Urology, St. Marianna University School of Medicine Hospital, Kawasaki,
Kanagawa, Japan. Electronic address: m2naka@marianna-u.ac.jp.
Sasaki, H. Department of Urology, St. Marianna University School of Medicine Hospital, Kawasaki,
Kanagawa, Japan.
Yazawa, M. Division of Nephrology and Hypertension, St. Marianna University School of Medicine
Hospital, Kawasaki, Kanagawa, Japan.
Imai, N. Division of Nephrology and Hypertension, St. Marianna University School of Medicine
Kawarazaki, H. Division of Nephrology and Hypertension, St. Marianna University School of Medicine
Shibagaki, Y. Division of Nephrology and Hypertension, St. Marianna University School of Medicine
Kimura, K. Division of Nephrology and Hypertension, St. Marianna University School of Medicine
Saito, Y. Recipient Renal Transplantation coordinator, St. Marianna University School of Medicine
Sakurai, Y. Recipient Renal Transplantation coordinator, St. Marianna University School of Medicine
Chikaraishi, T. Department of Urology, St. Marianna University School of Medicine Hospital, Kawasaki,
Kanagawa, Japan.
Adult
Aged
Data Collection
Female
Humans
Male
Middle Aged
Abstract
OBJECTIVE: To prevent the metabolic syndrome preventive in kidney transplant recipients, we measured
changes in body composition parameters using bioelectrical impedance analysis (BIA), and measuring
renal function, blood tests, quality of life, and consciousness of life improvement. The usefulness of BIA
was investigated.
SUBJECTS AND METHODS: Out of all kidney transplant recipients being treated at an outpatient
clinic, 20 (13 males and 7 females) gained >= 5 kg after transplantation. We investigated changes after 6
months of physical activity versus initiation.
RESULTS: After the initiation of body composition parameters using BIA, consciousness of life
improvement changed, and measured body composition values and blood data did not worsen. Both
systolic and diastolic blood pressures tended to decrease after initiation.
CONCLUSIONS: Detailed visualization of body composition in addition to the body weight and body
mass index, as well as guidance based on the results promoted changes in consciousness, enhanced self-
efficacy, and increased motivation for the prevention of the metabolic syndrome, suggesting that BIA is a
useful tool in the management of weight gain after kidney transplantation. Copyright © 2014 Elsevier Inc.
Publication Type
Journal Article.
Year of Publication
2014
Page 79
<154>
Unique Identifier
24656007
Title
Short-term prospective study of metabolic syndrome in renal transplant recipients.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Shu KH; Wu MJ; Chen CH; Cheng CH; Yu TM; Chuang YW; Huang ST; Tsai SF; Lo YC; Weng SC;
Wen MC; Ho HC.
Authors Full Name
Shu, K-H; Wu, M-J; Chen, C-H; Cheng, C-H; Yu, T-M; Chuang, Y-W; Huang, S-T; Tsai, S-F; Lo, Y-C;
Weng, S-C; Wen, M-C; Ho, H-C.
Institution
Shu, K-H. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Hospital, Taichung, Taiwan; Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan.
Electronic address: khshu@vghtc.gov.tw.
Wu, M-J. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Chen, C-H. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
Cheng, C-H. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Yu, T-M. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Hospital, Taichung, Taiwan.
Chuang, Y-W. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Huang, S-T. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Tsai, S-F. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Lo, Y-C. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Weng, S-C. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Wen, M-C. Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan.
Ho, H-C. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung,
Taiwan.
Aged
Female
Humans
Male
Page 80
*Metabolic Syndrome/co [Complications]
Middle Aged
Prospective Studies
Abstract
BACKGROUND: Metabolic syndrome (MS) may affect patient and graft survival in renal transplant
recipients. However, the evolution of MS during prospective follow-up remains uncertain.
METHODS: Renal transplant patients were recruited for a study of MS in 2010 and then prospectively
followed for 2 years. The modified Adult Treatment Panel III criteria adopted for Asian populations were
used to define MS.
RESULTS: A total of 302 cases (male:female = 154:148) with a mean duration of 10.5 +/- 5.7 years after
transplantation were enrolled. At initiation, 71 cases (23.5%) fulfilled the criteria of MS. At the end of
follow-up, 11 cases had died and 21 had graft failure. Nine cases had insufficient data for reclassification.
The remaining 261 cases completed a 2-year follow-up, and the prevalence of MS was 26.1% at the end of
study. Of these, 7.79% (18 cases) of patients without MS had developed new-onset MS. Conversely, 16.9%
(12 cases) with MS were free from MS at the end of study (P = .362). Patients with MS were associated
with older age (57.1 +/- 10.4 vs 52.6 +/- 12.4 y; P = .006), more chronic allograft nephropathy (17.4% vs
7.1%; P = .01), proteinuria (22.5% vs 10.8%; P = .012), and use of more antihypertensive agents (1.49 +/-
0.86 vs 0.80 +/- 0.98; P < .0001). There was no significant change in serum creatinine in each subgroup.
CONCLUSIONS: The status of MS in renal transplant patients is dynamic. MS patients were associated
with more chronic allograft nephropathy and proteinuria. Copyright © 2014 Elsevier Inc. All rights
reserved.
Publication Type
Year of Publication
2014

<155>
Unique Identifier
24656006
Title
Insulin resistance as a risk factor for new-onset diabetes after kidney transplantation.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Tokodai K; Amada N; Haga I; Takayama T; Nakamura A; Kashiwadate T.
Authors Full Name
Tokodai, K; Amada, N; Haga, I; Takayama, T; Nakamura, A; Kashiwadate, T.
Institution
Tokodai, K. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan. Electronic address:
tsu7ka5so8mi@yahoo.co.jp.
Amada, N. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan.
Haga, I. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan.
Page 81
Takayama, T. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan.
Nakamura, A. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan.
Kashiwadate, T. Department of Surgery, Sendai Shakaihoken Hospital, Miyagi, Japan.
Adult
*Diabetes Mellitus, Type 2/et [Etiology]
Female
Humans
*Insulin Resistance
Male
Middle Aged
Risk Factors
Abstract
INTRODUCTION: New-onset diabetes after transplantation (NODAT) is a serious and common
complication after kidney transplantation. Insulin resistance, together with beta-cell dysfunction, plays an
essential role in the development of diabetes. Homeostasis model assessment of insulin resistance (HOMA-
IR), which is calculated as [fasting plasma glucose (mmol/L) x fasting insulin (mU/L)]/22.5, is widely used
as an index of insulin resistance. However, the correlation between pretransplant HOMA-IR and the
development of NODAT has not been fully established.
METHODS: We performed a retrospective study of 44 nondiabetic patients who underwent living donor
kidney transplantation in our hospital from July 2006 to October 2009. We compared the HOMA-IR and
demographic variables of patients who developed NODAT with those who did not.
RESULTS: Five patients (11.4%) developed NODAT within 3 years after transplantation. There were no
differences in demographic variables between patients who developed NODAT and those who did not.
Logistic regression analysis revealed that HOMA-IR was a predictive factor of NODAT (odds ratio, 2.88;
95% CI, 1.11-9.59; P < .05).
CONCLUSIONS: Our results indicate that high HOMA-IR might be an important predictive factor for
NODAT. These findings underline the importance of routine pretransplant measurements of fasting plasma
glucose and serum insulin for evaluating HOMA-IR. Copyright © 2014 Elsevier Inc. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2014

<156>
Unique Identifier
24656004
Title
Association between use of FK506 and prevalence of post-transplantation diabetes mellitus in kidney
transplant patients.
Source
VI 1
Record Owner
Page 82
Status
MEDLINE
Authors
Weng LC; Chiang YJ; Lin MH; Hsieh CY; Lin SC; Wei TY; Chou HF.
Authors Full Name
Weng, L C; Chiang, Y J; Lin, M H; Hsieh, C Y; Lin, S C; Wei, T Y; Chou, H F.
Institution
Weng, L C. School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Chiang, Y J. Transplantation Center and Urology Surgery, Chang Gung Medical Foundation-Linkuo
Medical Center, Taoyuan, Taiwan. Electronic address: zorro@cgmh.org.tw.
Lin, M H. Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan,
Taiwan.
Hsieh, C Y. Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan,
Taiwan.
Lin, S C. Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan,
Taiwan.
Wei, T Y. Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan,
Taiwan.
Chou, H F. School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Adult
Female
Humans
Male
Middle Aged
Prevalence
Abstract
BACKGROUND: Tacrolimus (FK506) use has been suggested as a risk factor for post-transplantation
diabetes mellitus (PTDM) because it can impair insulin secretion. This association warrants further
investigation. This study aimed to examine the prevalence of PTDM and its association with FK506 use in
kidney transplant recipients. The study also aimed to examine the relationship of FK506 use and diabetes-
related biologic markers.
METHODS: A retrospective chart review was used to collect data at a medical center in northern Taiwan
from September 2003 to February 2012. PTDM was defined with the use of the criteria of the American
Diabetes Association.
RESULTS: Among 166 patients included in the analysis, PTDM was reported in 49 patients (29.5%). A
total of 93 patients used the FK506 regimen, of whom 34 (36.6%) were PTDM cases. Logistic regression
showed that FK506 use (odds ratio [OR], 2.71; 95% confidence interval [CI], 1.20-6.11; P = .016) and
older age (OR,1.08; 95% CI, 1.03-1.13; P = .001) were significant risk factors for PTDM. In addition,
FK506 use in PTDM cases was associated with a significantly higher hemoglobin A1c level (7.55 vs 5.81;
P = .01) and a borderline significantly higher insulin resistance index (3.24 vs 1.92; P = .053) than was
FK506 use without the presence of PTDM.
CONCLUSIONS: Older age and an FK506 regimen were important predictors of the prevalence of
PTDM. Greater early detection and prevention efforts for PTDM are needed for older transplant recipients.
PTDM patients with an FK506 regimen had higher hemoglobin A1c levels and insulin resistance index
than did patients who did not use FK506. The association of serum indicators with FK506 use in the
prevalence of PTDM warrants further investigation. Copyright © 2014 Elsevier Inc. All rights reserved.
Page 83
0 (Glycated Hemoglobin A). 0 (Immunosuppressive Agents). 0 (hemoglobin A1c protein, human).
WM0HAQ4WNM (Tacrolimus).
Publication Type
Journal Article.
Year of Publication
2014

<157>
Unique Identifier
24655968
Title
Serum adipokine levels in renal transplant recipients.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Shu KH; Wu MJ; Chen CH; Cheng CH; Yu TM; Chuang YW; Huang ST; Tsai SF; Lo YC; Weng SC;
Wen MC; Ho HC.
Authors Full Name
Shu, K-H; Wu, M-J; Chen, C-H; Cheng, C-H; Yu, T-M; Chuang, Y-W; Huang, S-T; Tsai, S-F; Lo, Y-C;
Weng, S-C; Wen, M-C; Ho, H-C.
Institution
Electronic address: khshu@vghtc.gov.tw.
Wu, M-J. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Chen, C-H. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan.
Cheng, C-H. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Yu, T-M. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Chuang, Y-W. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Huang, S-T. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Tsai, S-F. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Lo, Y-C. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Weng, S-C. Division of Nephrology, Department of Internal Medicine, Taichung Veterans General
Wen, M-C. Department of Pathology, Taichung Veterans General Hospital, Taichung, Taiwan.
Page 84
Ho, H-C. Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung,
Taiwan.
*Adipokines/bl [Blood]
Adult
Female
Humans
Male
Middle Aged
Abstract
BACKGROUND: Metabolic syndrome (MS) is a common complication in renal transplant (RTx)
recipients. This study aimed to explore the alterations and interrelationship of various adipokines in RTx
recipients with and without MS.
METHODS: RTx recipients followed at our hospital were randomly selected for the cross-sectional study
of MS. The modified Adult Treatment Panel III criteria adopted for Asian populations were used to define
MS. Overnight fasting blood samples were obtained for determination of adipokines, including adiponectin,
leptin, resistin, and visfatin. Univariate and multivariate logistic regressions were performed to determine
parameters that were associated with serum adipokine levels. Pearson correlation analysis was performed
between adipokines.
RESULTS: A total of 280 RTx recipients were enrolled for the study. Seventy-three cases (26.1%)
fulfilled the criteria of MS. A significantly higher serum leptin level was found in MS patients (16.61 +/-
13.90 vs 8.00 +/- 7.42 mug/mL; P < .0001). There was no significant difference in serum levels of
adiponectin, resistin, and visfatin between the 2 groups. Serum adiponectin level was positively correlated
with serum resistin (r = 0.422; P < .0001) and visfatin levels (r = 0.224; P < .0001). Serum resistin level
was positively correlated with serum visfatin level. All but serum visfatin level were negatively correlated
with estimated glomerular filtration rate. Univariate logistic regression revealed the following variables to
be associated with serum leptin level: metabolic syndrome, sex, body weight, waist circumference, body
mass index (BMI), hypertension, serum creatinine, fasting blood sugar, HbA1c, serum triglyceride, and uric
acid. Multivariate analysis revealed that sex, body weight, BMI, and serum creatinine were associated with
serum leptin level.
CONCLUSIONS: Compared with RTx recipients without MS, patients with MS were associated with
significantly higher serum leptin levels and similar adiponectin, resistin, and visfatin levels. A close
interrelationship was also found in the serum levels of these adipokines. Copyright © 2014 Elsevier Inc. All
rights reserved.
0 (Adipokines).
Publication Type
Year of Publication
2014

<158>
Unique Identifier
24609888
Title
Page 85
Lower magnesium level associated with new-onset diabetes and pre-diabetes after kidney transplantation.
Source
Journal of Nephrology. 27(3):339-44, 2014 Jun.
VI 1
Record Owner
Status
MEDLINE
Authors
Garg N; Weinberg J; Ghai S; Bradauskaite G; Nuhn M; Gautam A; Kumar N; Francis J; Chen JL.
Authors Full Name
Garg, Neetika; Weinberg, Janice; Ghai, Sandeep; Bradauskaite, Gitana; Nuhn, Matthew; Gautam,
Amitabh; Kumar, Nilay; Francis, Jean; Chen, Joline L T.
Institution
Garg, Neetika. Department of Internal Medicine, Boston University Medical Center, Boston, MA, 02118,
USA, neetika84@gmail.com.
Boston
Down-Regulation
Female
Humans
Logistic Models
*Magnesium/bl [Blood]
Male
Middle Aged
Odds Ratio
Prediabetic State/bl [Blood]
Prediabetic State/di [Diagnosis]
*Prediabetic State/et [Etiology]
Risk Factors
Time Factors
Treatment Outcome
Abstract
BACKGROUND: Hypomagnesemia is associated with increased peripheral insulin resistance in the
general population. It is frequently seen after renal transplantation. We examined its role as a risk factor for
new-onset diabetes after transplantation (NODAT) and new-onset pre-diabetes after transplantation
(NOPDAT).
METHODS: A retrospective analysis of 138 previously non-diabetic renal transplant recipients was
conducted. Cox and logistic regression analyses were performed to examine the associations between 1-
month post-transplant serum magnesium level and subsequent diagnoses of NODAT/NOPDAT.
RESULTS: NODAT was diagnosed in 34 (24.6 %) and NOPDAT in 12 (8.7 %) patients. Median time to
diagnosis of NODAT/NOPDAT was 20.4 months (interquartile range [IQR] 6.8-34.8). Median follow up
for the entire group was 3.5 years (IQR 2.3-5.6). Mean magnesium level at 1 month after transplantation
was significantly lower in patients subsequently diagnosed with NODAT/NOPDAT (1.60 +/- 0.27 vs. 1.76
+/- 0.29 mg/dl, p = 0.002). Cox regression analysis identified a trend towards developing
NODAT/NOPDAT with lower baseline magnesium levels (hazard ratio 0.89 per 0.1 mg/dl increment in
Page 86
magnesium level, 95 % confidence interval [CI] = 0.78-1.01, p = 0.07); a stronger relationship between the
two variables was seen at logistic regression analysis (odds ratio 0.81 per 0.1 mg/dl increment in serum
magnesium (95 % CI 0.67-0.98, p = 0.03).
CONCLUSIONS: A lower magnesium level at 1 month after transplantation may be predictive of a

subsequent diagnosis of glucose intolerance or diabetes in renal transplant recipients. Whether replenishing
magnesium stores can prevent development of these disorders requires further investigation.
0 (Biomarkers). I38ZP9992A (Magnesium).
Publication Type
Journal Article.
Year of Publication
2014

<159>
Unique Identifier
24606122
Title
Metabolic risk factors and long-term graft function after paediatric renal transplantation.
Source
Transplant International. 27(6):583-92, 2014 Jun.
VI 1
Record Owner
Status
MEDLINE
Authors
Tainio J; Qvist E; Holtta T; Pakarinen M; Jahnukainen T; Jalanko H.
Authors Full Name
Tainio, Juuso; Qvist, Erik; Holtta, Tuula; Pakarinen, Mikko; Jahnukainen, Timo; Jalanko, Hannu.
Institution
Tainio, Juuso. Children's Hospital, University of Helsinki and Helsinki University Central Hospital,
Helsinki, Finland.
Adolescent
Age Factors
Blood Chemical Analysis
Child
Child, Preschool
Databases, Factual
Female
Finland
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
Infant
Page 87
*Kidney Transplantation/mt [Methods]
Male
Postoperative Care
Postoperative Complications/pp [Physiopathology]
Reoperation/mt [Methods]
Risk Assessment
Sex Factors
Statistics, Nonparametric
Time Factors
Treatment Outcome
Keyword Heading
adolescents
children
glomerular filtration rate
metabolic syndrome
renal transplantation
risk factors
Abstract
The aim of this study was to evaluate metabolic risk factors and their impact on long-term allograft
function in paediatric renal transplant (RTx) patients. We reviewed the medical records of 210 RTx patients
who underwent transplantation at a median age of 4.5 years (range 0.7-18.2) and a median follow-up of 7.0
years (range 1.5-18.0). Data on lipid and glucose metabolism, uric acid levels, weight and blood pressure
were collected up to 13 years post-RTx, and the findings were correlated with the measured glomerular
filtration rate (GFR). Beyond the first year, GFR showed gradual deterioration with a mean decline of 2.4
ml/min/1.73 m(2)/year. Metabolic syndrome, overweight, hypertension and type 2 diabetes were diagnosed
in 14-19%, 20-23%, 62-87% and 3-5% of the patients, respectively. These entities showed only mild
association with the concomitant or long-term GFR values. Dyslipidaemia was common and
hypertriglyceridaemia associated with a lower GFR at 1.5 and 5 years post-RTx (P = 0.008 and P = 0.017,
respectively). Similarly, hyperuricaemia was frequent and associated significantly with GFR (P < 0.001).
Except for hyperuricaemia and hypertriglyceridaemia, metabolic risk factors beyond the first postoperative
year associated modestly with the long-term kidney graft function in paediatric RTx patients. Copyright ©
2014 Steunstichting ESOT.
Publication Type
Year of Publication
2014

<160>
Unique Identifier
24507957
Title
Obesity, metabolic syndrome and diabetes mellitus after renal transplantation: prevention and treatment.
[Review]
Source
Transplantation Reviews. 28(2):37-46, 2014 Apr.
VI 1
Page 88
Record Owner
Status
MEDLINE
Authors
Wissing KM; Pipeleers L.
Authors Full Name
Wissing, Karl Martin; Pipeleers, Lissa.
Institution
Wissing, Karl Martin. Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit
Brussel, Brussels, Belgium; Nephrology and Dialysis Clinic, Centre Hospitalier Universitaire Brugmann,
Brussels, Belgium. Electronic address: kwissing@uzbrussel.be.
Pipeleers, Lissa. Nephrology Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel,
Brussels, Belgium.
Adrenal Cortex Hormones/ae [Adverse Effects]
Adrenal Cortex Hormones/tu [Therapeutic Use]
Combined Modality Therapy
Diabetes Mellitus/pc [Prevention & Control]
Female
Graft Rejection
Graft Survival
Humans
Kidney Failure, Chronic/di [Diagnosis]
Male
*Metabolic Syndrome/th [Therapy]
Obesity/pc [Prevention & Control]
*Primary Prevention/mt [Methods]
Prognosis
Risk Assessment
Severity of Illness Index
Treatment Outcome
Abstract
The prevalence of the metabolic syndrome in dialysis patients is high and further increases after
transplantation due to weight gain and the detrimental metabolic effects of immunosuppressive drugs.
Corticosteroids cause insulin resistance, hyperlipidemia, abnormal glucose metabolism and arterial
hypertension. The calcineurin inhibitor tacrolimus is diabetogenic by inhibiting insulin secretion, whereas
cyclosporine causes hypertension and increases cholesterol levels. Mtor antagonists are responsible for
hyperlipidemia and abnormal glucose metabolism by mechanisms that also implicate insulin resistance.
The metabolic syndrome in transplant recipients has numerous detrimental effects such as increasing the
risk of new onset diabetes, cardiovascular disease events and patient death. In addition, it has also been
linked with accelerated loss of graft function, proteinuria and ultimately graft loss. Prevention and
management of the metabolic syndrome are based on increasing physical activity, promotion of weight loss
and control of cardiovascular risk factors. Bariatric surgery before or after renal transplantation in patients
with body mass index >35 kg/m(2) is an option but its long term effects on graft and patient survival have
Page 89
not been investigated. Steroid withdrawal and replacement of tacrolimus with cyclosporine facilitate
control of diabetes, whereas replacement of cyclosporine and mtor antagonists can improve hyperlipidemia.
The new costimulation inhibitor belatacept has potent immunosuppressive properties without metabolic
adverse effects and will be an important component of immunosuppressive regimens with better metabolic
risk profile. Medical treatment of cardiovascular risk factors has to take potential drug interactions with
immunosuppressive medication and drug accumulation due to renal insufficiency into account. Copyright
© 2014 Elsevier Inc. All rights reserved.
0 (Adrenal Cortex Hormones). 0 (Immunosuppressive Agents).
Publication Type
Year of Publication
2014

<161>
Unique Identifier
24398851
Title
Long-term progression of abnormal glucose tolerance and its relationship with the metabolic syndrome
Source
Transplantation. 97(5):576-81, 2014 Mar 15.
VI 1
Record Owner
Status
MEDLINE
Authors
Nagaraja P; Sharif A; Ravindran V; Baboolal K.
Authors Full Name
Nagaraja, Pramod; Sharif, Adnan; Ravindran, Vinod; Baboolal, Keshwar.
Institution
Nagaraja, Pramod. 1 Directorate of Nephrology and Transplantation, University Hospital of Wales,
Cardiff, UK. 2 Renal Institute of Birmingham, Queen Elizabeth Hospital, Birmingham, UK. 3 Address
correspondence to: Pramod Nagaraja, M.D., Directorate of Nephrology and Transplantation, University
Hospital of Wales, Cardiff CF14 4XW, UK.
Adult
*Disease Progression
Female
Follow-Up Studies
Glucose Intolerance/co [Complications]
*Glucose Intolerance/me [Metabolism]
Humans
Logistic Models
Male
Page 90
*Metabolic Syndrome/me [Metabolism]
Middle Aged
Risk Factors
Time Factors
Abstract
BACKGROUND: Metabolic syndrome (MS) diagnosed early after kidney transplantation is a risk factor
for developing new-onset diabetes. The aim of this study was to examine whether glucose intolerance and
MS identified late after transplantation influence the progression of glycemic abnormalities in kidney
METHODS: This is a retrospective study in which 76 non-diabetic renal transplant recipients underwent
oral glucose tolerance tests (OGTT) in 2005 to 2006 (baseline) and then in 2011 to 2012 (follow-up). MS
was identified using the International Diabetes Federation criteria and OGTT was interpreted according to
the WHO classification.
RESULTS: At follow-up, median time from transplantation was 11.1 years (range 6.2-23.8). Mean 0-
hour and 2-hour plasma glucose levels were significantly higher at follow-up compared to baseline (5.7 +/-
0.7 vs. 5.9 +/- 0.9 mmol/L, P=0.03 and 6.7 +/- 1.9 vs. 7.5 +/- 2.8 mmol/L, P=0.03, respectively). The
proportion of patients with an abnormal OGTT increased from 42% at baseline to 61% at follow-up
(P=0.007). Patients with MS were more likely to progress to a higher degree of glucose intolerance
compared to those without MS (58% vs. 27%, P=0.01). On multivariable logistic regression adjusted for
age and gender, MS was significantly associated with the progression of glucose intolerance (OR 3.5, CI
1.2-9.9, P=0.01), as was a fasting glucose greater than 5.6 mmol/L (OR 4.8, CI 1.6-14.8, P=0.006).
CONCLUSION: MS is a risk factor for the progression of glucose intolerance in renal transplant
recipients in the late posttransplant period. Therefore, MS has to be considered in tandem with OGTT
results to assess cardiovascular risk.
IY9XDZ35W2 (Glucose).
Publication Type
Journal Article. Observational Study.
Year of Publication
2014

<162>
Unique Identifier
24309190
Title
Genetics of new-onset diabetes after transplantation.
Source
Journal of the American Society of Nephrology. 25(5):1037-49, 2014 May.
VI 1
Record Owner
Status
MEDLINE
Authors
McCaughan JA; McKnight AJ; Maxwell AP.
Page 91
Authors Full Name
McCaughan, Jennifer A; McKnight, Amy Jayne; Maxwell, Alexander P.
Institution
McCaughan, Jennifer A. Nephrology Research Group, Queen's University, Belfast, Northern Ireland; and
Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland jamccaughan@doctors.org.uk.
McKnight, Amy Jayne. Nephrology Research Group, Queen's University, Belfast, Northern Ireland; and.
Maxwell, Alexander P. Nephrology Research Group, Queen's University, Belfast, Northern Ireland; and
Regional Nephrology Unit, Belfast City Hospital, Belfast, Northern Ireland.
Adolescent
Adult
Aged
Child
Child, Preschool
Cohort Studies
*Diabetes Mellitus/ge [Genetics]
Diabetes Mellitus/pa [Pathology]
European Continental Ancestry Group/ge [Genetics]
Female
Genome-Wide Association Study
Genotyping Techniques
Humans
Infant
Male
Middle Aged
Polymorphism, Single Nucleotide
*Postoperative Complications/ge [Genetics]
Young Adult
Abstract
New-onset diabetes after transplantation is a common complication that reduces recipient survival.
Research in renal transplant recipients has suggested that pancreatic beta-cell dysfunction, as opposed to
insulin resistance, may be the key pathologic process. In this study, clinical and genetic factors associated
with new-onset diabetes after transplantation were identified in a white population. A joint analysis
approach, with an initial genome-wide association study in a subset of cases followed by de novo
genotyping in the complete case cohort, was implemented to identify single-nucleotide polymorphisms
(SNPs) associated with the development of new-onset diabetes after transplantation. Clinical variables
associated with the development of diabetes after renal transplantation included older recipient age, female
sex, and percentage weight gain within 12 months of transplantation. The genome-wide association study
identified 26 SNPs associated with new-onset diabetes after transplantation; this association was validated
for eight SNPs (rs10484821, rs7533125, rs2861484, rs11580170, rs2020902, rs1836882, rs198372, and
rs4394754) by de novo genotyping. These associations remained significant after multivariate adjustment
for clinical variables. Seven of these SNPs are associated with genes implicated in beta-cell apoptosis.
These results corroborate recent clinical evidence implicating beta-cell dysfunction in the pathophysiology
of new-onset diabetes after transplantation and support the pursuit of therapeutic strategies to protect beta
cells in the post-transplant period. Copyright © 2014 by the American Society of Nephrology.
Publication Type
Journal Article. Research Support, Non-U.S. Gov't. Validation Studies.
Year of Publication
2014
Page 92
<163>
Unique Identifier
24280560
Title
Non-alcoholic fatty liver disease; a part of the metabolic syndrome in the renal transplant recipient and
possible cause of an allograft dysfunction.
Source
Medical Hypotheses. 82(1):36-9, 2014 Jan.
VI 1
Record Owner
Status
MEDLINE
Authors
Mikolasevic I; Racki S; Lukenda V; Pavletic-Persic M; Milic S; Orlic L.
Authors Full Name
Mikolasevic, I; Racki, S; Lukenda, V; Pavletic-Persic, M; Milic, S; Orlic, L.
Institution
Mikolasevic, I. Department of Nephrology and Dialysis, Division of Internal Medicine, University
Hospital Center Rijeka, Rijeka, Croatia. Electronic address: ivana.mikolasevic@gmail.com.
Racki, S. Department of Nephrology and Dialysis, Division of Internal Medicine, University Hospital
Center Rijeka, Rijeka, Croatia.
Lukenda, V. Department of Internal Medicine, General Hospital "Dr. Josip Bencevic", Slavonski Brod,
Croatia.
Pavletic-Persic, M. Department of Nephrology and Dialysis, Division of Internal Medicine, University
Hospital Center Rijeka, Rijeka, Croatia.
Milic, S. Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka,
Rijeka, Croatia.
Orlic, L. Department of Nephrology and Dialysis, Division of Internal Medicine, University Hospital
Center Rijeka, Rijeka, Croatia.
*Cardiovascular Diseases/et [Etiology]
Cardiovascular Diseases/mo [Mortality]
Fatty Liver/co [Complications]
*Fatty Liver/et [Etiology]
Humans
Insulin Resistance/ph [Physiology]
*Models, Biological
Non-alcoholic Fatty Liver Disease
Oxidative Stress/ph [Physiology]
*Primary Graft Dysfunction/et [Etiology]
Renin-Angiotensin System/ph [Physiology]
Abstract
Despite all improvements in transplant medicine, renal transplant recipients have a high risk for
cardiovascular mortality. A high prevalence of cardiovascular complications in renal transplant recipients
(RTR) is explained by cardiovascular risk factors present before transplantation, in addition to the
development of new risk factors as well as worsening of preexisting risk factors after transplantation. A
majority ot these patients develop metabolic syndrome within a year after the transplantation. The
metabolic syndrome (MS) is associated with impaired renal allograft function and increased insulin
Page 93
resistance. Non alcoholic fatty liver disease (NAFLD) represents a liver manifestation of metabolic
syndrome and it development is strongly associated with all components of MS in general population. The
current importance of NAFLD and its link to the MS has encouraged an interest in its possible role in the
development of atherosclerosis in recent years. Considering the fact that all components of MS are more
common among renal transplant recipients compared to general population, it would be expected that RTR
may have a much higher incidence of NAFLD compared to general population. We propose that the
presence of NAFLD in RTR could be a strong predictor in cardiovascular morbidity and mortality. Also,
according to the recent investigations about the possible link between NAFLD and chronic kidney disease,
we hypothesis that NAFLD may be associated with deteriorating graft function, causing a chronic allograft
nephropathy and graft loss. Common factors underlying the pathogenesis of NAFLD and chronic allograft
dysfunction may be insulin resistance, oxidative stress, activation of rennin-angiotensin system, and
inappropriate secretion of inflammatory cytokines by steatotic and inflamed liver. Copyright © 2013
Elsevier Ltd. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2014

<164>
Unique Identifier
24120605
Title
Current applications of therapeutic phlebotomy. [Review]
Source
Blood Transfusion. 12 Suppl 1:s75-83, 2014 Jan.
VI 1
Record Owner
Status
MEDLINE
Authors
Assi TB; Baz E.
Authors Full Name
Assi, Tarek Bou; Baz, Elizabeth.
Institution
Assi, Tarek Bou. Department of Pathology and Laboratory Medicine, American University of Beirut
Medical Centre, Beirut, Lebanon.
Baz, Elizabeth. Department of Pathology and Laboratory Medicine, American University of Beirut
Medical Centre, Beirut, Lebanon.
Anemia, Sickle Cell/th [Therapy]
Biopsy
Complementary Therapies
Diagnosis, Differential
Erythropoietin/bl [Blood]
Hemochromatosis/di [Diagnosis]
*Hemochromatosis/th [Therapy]
Hepatitis C, Chronic/th [Therapy]
Humans
Iron/me [Metabolism]
Page 94
Liver/pa [Pathology]
Metabolic Syndrome/th [Therapy]
*Phlebotomy
Polycythemia/bl [Blood]
Polycythemia/di [Diagnosis]
Polycythemia/et [Etiology]
Polycythemia/th [Therapy]
Polycythemia Vera/di [Diagnosis]
*Polycythemia Vera/th [Therapy]
Porphyria Cutanea Tarda/di [Diagnosis]
Porphyria Cutanea Tarda/pa [Pathology]
*Porphyria Cutanea Tarda/th [Therapy]
Postoperative Complications/bl [Blood]
11096-26-7 (Erythropoietin). E1UOL152H7 (Iron).
Publication Type
Year of Publication
2014

<165>
Unique Identifier
23760991
Title
Metabolic syndrome in children with chronic kidney disease and after renal transplantation. [Review]
Source
Pediatric Nephrology. 29(2):203-16, 2014 Feb.
VI 1
Record Owner
Status
MEDLINE
Authors
Litwin M; Niemirska A.
Authors Full Name
Litwin, Mieczyslaw; Niemirska, Anna.
Institution
Litwin, Mieczyslaw. Department of Nephrology and Arterial Hypertension, The Children's Memorial
Health Institute, Warsaw, Poland, m.litwin@czd.pl.
Child
Humans
*Renal Insufficiency, Chronic/co [Complications]
*Renal Insufficiency, Chronic/su [Surgery]
Abstract
Page 95
Visceral obesity and metabolic abnormalities typical for metabolic syndrome (MS) are the new epidemic
in adolescence. MS is not only the risk factor for cardiovascular disease but also for chronic kidney disease
(CKD). Thus, there are some reasons to recognize MS as a new challenge for pediatric nephrologists. First,
hypertensive and diabetic nephropathy, the main causes of CKD in adults, both share the same
pathophysiological abnormalities associated with visceral obesity and insulin resistance and have their
origins in childhood. Secondly, as the obesity epidemic also affects children with CKD, MS emerges as the
risk factor for progression of CKD. Thirdly, metabolic abnormalities typical for MS may pose additional
risk for cardiovascular morbidity and mortality in children with CKD. Finally, although the renal
transplantation reverses uremic abnormalities it is associated with an exposure to new metabolic risk
factors typical for MS and MS has been found to be the risk factor for graft loss and cardiovascular
morbidity after renal transplantation. MS is the result of imbalance between dietary energy intake and
expenditure inducing disproportionate fat accumulation. Thus, the best prevention and treatment of MS is
physical activity and maintenance of proper relationship between lean and fat mass.
Publication Type
Year of Publication
2014

<166>
Unique Identifier
24402110
Title
Evaluation of metabolic syndrome and associations with inflammation and graft function in renal
Source
Jornal Brasileiro de Nefrologia. 35(4):299-307, 2013 Oct-Dec.
VI 1
Record Owner
Status
MEDLINE
Authors
de Alencastro MG; Lemos JR; Bastos NM; Vicari AR; Goncalves LF; Manfro RC.
Authors Full Name
de Alencastro, Mariana Gascue; Lemos, Joana Raquel Nunes; Bastos, Nicia Maria Romano de Medeiros;
Vicari, Alessandra Rosa; Goncalves, Luiz Felipe Santos; Manfro, Roberto Ceratti.
Adult
Female
Humans
Inflammation/co [Complications]
*Inflammation/pp [Physiopathology]
*Kidney/pp [Physiopathology]
Male
Middle Aged
*Postoperative Complications/pp [Physiopathology]
Page 96
Abstract
INTRODUCTION: Cardiovascular disease (CVD) is a major determinant of mortality in renal transplant
recipients (RTR). Metabolic syndrome (MS) and chronic inflammation are currently considered non
traditional risk factors for cardiovascular disease. This study evaluates the frequency of these conditions
their associations with graft function.
OBJECTIVE: To evaluate the prevalence of metabolic syndrome (MS) and inflammation and their
associations with graft function in renal transplant recipients.
METHODS: A cross-sectional study was carried out with 200 RTR. MS was defined by the NCEP-ATP
III criteria. Inflammation was assessed by CRP levels. Renal function was assessed by GFR estimation
using the MDRD equation.
RESULTS: MS occurred in 71 patients (35.5%). Patients with MS had higher CPR and decreased GFR
levels. Inflammation was present in 99 patients (49.5%). Mean waist perimeter, body mass index,
triglycerides and serum total cholesterol were significantly higher in inflamed patients. An association
between MS and inflammation was demonstrated, 48 (67.6%) patients with MS were inflamed and among
those without MS the rate of inflamed patients was 39.5% (51 patients) (p < 0.001). A significantly higher
percentage of patients with MS in the group of patients in chronic renal disease stages III and IV was
observed.
CONCLUSION: In RTR there is a significant association among MS and inflammation. MS is negatively

associated with graft function. The clinical implications of these findings must be evaluated in longitudinal
studies.
Publication Type
Year of Publication
2013

<167>
Unique Identifier
24315001
Title
Examination of carbohydrate metabolism parameters after simultaneous pancreas-kidney transplantation.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Foldes K; Piros L; Toronyi E; Wagner L; Chmel R; Torok S; Nagy K; Ghimessy A; Brinzanek D; Pocze
B; Langer RM; Gero L.
Authors Full Name
Foldes, K; Piros, L; Toronyi, E; Wagner, L; Chmel, R; Torok, Sz; Nagy, K; Ghimessy, A; Brinzanek, D;
Pocze, B; Langer, R M; Gero, L.
Institution
Foldes, K. Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary.
Page 97
Adult
Diabetes Mellitus, Type 1/bl [Blood]
Diabetes Mellitus, Type 1/co [Complications]
Diabetes Mellitus, Type 1/di [Diagnosis]
*Diabetes Mellitus, Type 1/su [Surgery]
Diabetic Nephropathies/bl [Blood]
Diabetic Nephropathies/di [Diagnosis]
Diabetic Nephropathies/et [Etiology]
*Diabetic Nephropathies/su [Surgery]
Fasting/bl [Blood]
Female
*Glycated Hemoglobin A/me [Metabolism]
Graft Survival
Humans
Hypoglycemic Agents/tu [Therapeutic Use]
Insulin/bl [Blood]
Insulin Resistance
Kidney Failure, Chronic/et [Etiology]
*Liver Transplantation
Male
Middle Aged
Time Factors
Treatment Outcome
Abstract
End-stage renal failure, a frequent complication of type 1 diabetes mellitus, requires renal replacement
therapy. Our team examined the laboratory parameters of carbohydrate metabolism in 18 patients with type
1 diabetes at 10 to 89 months after simultaneous pancreas-kidney transplantation. We compared these
results with those of 17 patients with type 1 diabetes who had formerly received kidney-alone
transplantations, and were undergoing insulin treatment, as well as with those of 16 metabolically healthy
controls. The hemoglobin A1c (HbA1c) and blood glucose levels of the pancreas-kidney transplant
recipients were within the normal ranges, not differing significantly from those of the healthy controls. In
contrast, the HbA1c and glucose levels were significantly elevated among kidney transplanted diabetic
subjects. However, fasting and 2-hour insulin levels of pancreas-kidney transplant patients were
significantly higher than those of the controls, indicating insulin resistance. According to these results, the
insulin secretion by the pancreas graft sufficiently compensated for insulin resistance. Thus 10 to 89
months after successful pancreas-kidney transplantation, carbohydrate metabolism by type 1 diabetic
patients was well controlled without antidiabetic therapy. Copyright © 2013 Elsevier Inc. All rights
reserved.
0 (Biomarkers). 0 (Blood Glucose). 0 (Glycated Hemoglobin A). 0 (Hypoglycemic Agents). 0 (Insulin). 0
(hemoglobin A1c protein, human).
Publication Type
Comparative Study. Journal Article.
Year of Publication
2013

Page 98
<168>
Unique Identifier
24314947
Title
Metabolic syndrome performs better than the individual factors in predicting renal graft outcome.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Mohsin N; Mourad G; Faure M; Szawarc I; Bringer J.
Authors Full Name
Mohsin, N; Mourad, G; Faure, M; Szawarc, I; Bringer, J.
Institution
Mohsin, N. Department of Nephrology, Royal Hospital, Muscat, Oman. Electronic address:
nabilmohsin@gmail.com.
Adiposity
Blood Pressure
Graft Survival
Humans
Kidney/dg [Diagnostic Imaging]
Kidney/pp [Physiopathology]
*Kidney/su [Surgery]
Linear Models
Lipids/bl [Blood]
Radionuclide Imaging
Risk Factors
Time Factors
Treatment Outcome
Abstract
AIM: Individual components of the metabolic syndrome (MS), especially obesity and hypertension, have
a deleterious effect on renal graft outcome. Whether MS is better than its individual components in
predicting the decline of renal function is unknown. We studied the presence of MS and its individual
components at 12 months post-transplantation according to the Adult Treatment Panel III classification and
their influence on measured graft function.
METHODS: A cohort of 322 patients who underwent transplantation between 1996 and 2003 and who
agreed to have their glomerular filtration rate (GFR) measured by urinary clearance of technetium 99m
Page 99
(Tc*-DTPA) (measured GFR [mGFR]) at 3, 12, 48, 60, and 96 months after transplantation were included.
The patients were followed up until patient death, graft loss, or December 2009 (mean follow-up: 3 +/- 2.8
years). The linear mixed effect model for longitudinal repeated measures was applied. To compare MS
versus its components we used the Akaike information Criterion (AIC) to determine the best model
according to the Anderson and Burnham method.
RESULTS: Univariate and multivariate analyses models using MS were more efficient than those using
the individual components, which consisted of waist circumference, low high-density lipoprotein-
cholesterol, hypertriglyceridemia, hyperglycemia, and systolic and diastolic blood pressure. The AIC was
the lowest with MS models indicating better prediction on graft function than the individual components.
CONCLUSION: MS is a better predictor of mGFR decline than its individual components. It is a valid
and precious tool to assess outcomes. Copyright © 2013. Published by Elsevier Inc.
0 (Biomarkers). 0 (Blood Glucose). 0 (Lipids).
Publication Type
Year of Publication
2013

<169>
Unique Identifier
24314946
Title
Different classifications yield variance in metabolic syndrome prevalence and dynamics in renal
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Mohsin N; Faure M; Szwarc I; Pernin V; Mourad G.
Authors Full Name
Mohsin, N; Faure, M; Szwarc, I; Pernin, V; Mourad, G.
Institution
Mohsin, N. Department of Nephrology, Royal Hospital, Muscat, Oman. Electronic address:
nabilmohsin@gmail.com.
Adiposity
Blood Pressure
Humans
Insulin/bl [Blood]
Insulin Resistance
Kidney/pp [Physiopathology]
Page 100
*Kidney/su [Surgery]
Lipids/bl [Blood]
Metabolic Syndrome/cl [Classification]
Oman/ep [Epidemiology]
Prevalence
Time Factors
Abstract
INTRODUCTION: The metabolic syndrome (MS) is a combination of factors that are associated with
increased cardiovascular diseases. High MS prevalence was reported in renal transplant recipients.
However, little is known about the longitudinal prevalence and its dynamic properties in this population.
We studied the longitudinal prevalence of MS at 3 and 12 months post-transplantation using 3
classifications.
PATIENTS AND METHODS: We studied a cohort of 322 patients who underwent transplantation
between 1996 and 2003 who had isotopic measurement of transplant glomerular filtration rate and MS
assessment at 3 and 12 months after transplantation. Prevalence and change of MS status in terms of
acquisition or regression were analyzed based on World Health Organization (WHO), International
Diabetic Federation (IDF), and The Adult Treatment Panel-III (ATP-III) classifications.
RESULTS: The prevalences at 3 and 12 months were as follows: WHO, 8.4% and 8.1%; IDF, 25.8% and
29.8%; and ATP-III, 34.3% and 36.6%, respectively. Change in MS status was noted in 9.7%, 16.4%, and
20.5% of subjects within WHO, IDF, and the ATP-III classifications, respectively. Prevalence was
significantly lower with WHO than IDF and ATP-III. Prevalence was the highest with ATP-III. However,
the difference with IDF was significant only at 3 months post-transplantation. Depending on the
classification used, 10%-21% of subjects change MS status within the first year of transplantation.
CONCLUSION: Longitudinal analysis confirms the high prevalence of MS and also highlights the
dynamics of MS. We think both prevalence and dynamics should be accounted for when studying
outcomes. Copyright © 2013 Elsevier Inc. All rights reserved.
0 (Biomarkers). 0 (Blood Glucose). 0 (Insulin). 0 (Lipids).
Publication Type
Year of Publication
2013

<170>
Unique Identifier
24185422
Title
Genotypes of renin-angiotensin system and plasma adiponectin concentration in kidney transplant
patients.
Source
Page 101
Annals of Transplantation. 18:593-603, 2013 Nov 04.
VI 1
Record Owner
Status
MEDLINE
Authors
Chudek J; Szotowska M; Karkoszka H; Verbeke F; Trautsolt W; Gumprecht J; Vanholder R; Wiecek A.
Authors Full Name
Chudek, Jerzy; Szotowska, Magdalena; Karkoszka, Henryk; Verbeke, Francis; Trautsolt, Wanda;
Gumprecht, Janusz; Vanholder, Raymond; Wiecek, Andrzej.
Institution
Chudek, Jerzy. Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of
Silesia in Katowice, Katowice, Poland and Department of Pathophysiology, Medical University of Silesia
in Katowice, Katowice, Poland.
*Adiponectin/bl [Blood]
Adult
Angiotensinogen/ge [Genetics]
Female
Gene Frequency
*Genotype
Humans
Insulin Resistance/ge [Genetics]
Male
Middle Aged
Peptidyl-Dipeptidase A/ge [Genetics]
*Polymorphism, Genetic
Receptor, Angiotensin, Type 1/ge [Genetics]
*Renin-Angiotensin System/ge [Genetics]
Abstract
BACKGROUND: Low plasma adiponectin concentration was recently recognized as a novel risk factor
for new-onset diabetes after transplantation. Pharmacological modulation of the renin-angiotensin system
activity and genetic predisposition were shown to have an influence on plasma adiponectin level. Therefore
the aim of this study is to analyze the association between angiotensin-converting enzyme (ACE) I/D,
angiotensin II type 1 receptor (AT1R) A1166C and angiotensinogen (AGT) M235T genotypes and plasma
adiponectin concentration as well as insulin resistance in a cohort of kidney transplant patients.
MATERIAL/METHODS: AGT M235T, ACE I/D and AT1R A1166C genotyping and plasma
adiponectin and insulin concentrations assessment were performed in 372 patients with functioning kidney
allograft (eGFR >20 ml/min/1.73 m2) from 2 transplant centres.
RESULTS: Females with II ACE I/D genotype had a significantly higher plasma adiponectin
concentration than the ID+DD subgroup, which could partially be explained by a lower BMI in the II
subgroup. Males with TT genotype of the AGT M235T gene polymorphism (and higher BMI) had higher
plasma concentration of insulin and HOMAIR values than those in the MT+MM subgroup. A multiple
regression analysis revealed that only female sex (b=0.239), BMI (b=-0.208) and ACE II genotype
(b=0.129) were significantly associated with plasma adiponectin concentration variability. A similar
analysis for HOMA-IR showed that its variability was associated with BMI (b=0.333), eGFR (b=-0.115)
and plasma adiponectin concentration (b=-0.064) irrespective of any of the analyzed genotypes.
CONCLUSIONS: Plasma adiponectin concentration, but not insulin resistance, seems to be modulated
only by ACE I/D polymorphism in kidney transplant patients. Polymorphisms of the other renin-
angiotensin system components do not influence plasma adiponectin concentration or insulin resistance in
these patients.
Page 102
0 (Adiponectin). 0 (Receptor, Angiotensin, Type 1). 11002-13-4 (Angiotensinogen). EC 3-4-15-1
(Peptidyl-Dipeptidase A).
Publication Type
Journal Article.
Year of Publication
2013

<171>
Unique Identifier
24182799
Title
Progression of metabolic syndrome in renal transplant recipients.
Source
Transplantation Proceedings. 45(9):3273-8, 2013 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Oruc M; Koseoglu K; Seyahi N; Alagoz S; Trabulus S; Altiparmak MR.
Authors Full Name
Oruc, M; Koseoglu, K; Seyahi, N; Alagoz, S; Trabulus, S; Altiparmak, M R.
Institution
Oruc, M. Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul,
Turkey.
Comments
Erratum in (EIN)
Blood Pressure
Disease Progression
Homeostasis
Humans
Insulin Resistance
Lipids/bl [Blood]
*Metabolic Syndrome/pa [Pathology]
Abstract
BACKGROUND: Metabolic syndrome, which is closely related to insulin resistance, is highly prevalent
in renal transplant recipients.
PURPOSE: We aimed to investigate prevalence, risk factors, and progression of metabolic syndrome in
renal transplant recipients.
METHODS: One hundred fifty-eight renal transplant recipients who had been on transplantation for more
than 1 year and 79 age-sex matched healthy controls were included in the cross-sectional phase of the
Page 103
study. We measured baseline characteristics, blood pressure, fasting blood glucose, and lipid profiles and
we defined metabolic syndrome using the National Cholesterol Education Program Adult Treatment Panel
III criteria. One hundred twenty-four renal transplant recipients were eligible for the second evaluation after
22.9 +/- 3.8 months. Metabolic syndrome prevalence and homeostasis model assessment insulin resistance
levels were evaluated during the follow-up period.
RESULTS: Overall, metabolic syndrome was present in 34.2% of the patients and 12.7% of the controls
at the cross-sectional phase of the study (P = .000). Only the hypertension component of metabolic
syndrome was significantly increased in patients compared to controls (P = .000). Pretransplantation weight
and body mass index were significantly higher in patients who had metabolic syndrome (P = .000). During
the follow-up period, prevalence of metabolic syndrome did not change (P = .510); however, body mass
index and blood pressure increased and the high density lipoprotein cholesterol component of metabolic
syndrome decreased (P = .001). We did not find any significant difference in glomerular filtration rate
change among patients with and without metabolic syndrome (-2.2 +/- 11.36 vs -6.14 +/- 13.19; P = .091).
Glucose metabolism parameters including hemoglobin A1c, insulin, and homeostasis model assessment
insulin resistance were disturbed in patients with metabolic syndrome (P = .000, P = .001, P = .002,
respectively).
CONCLUSION: Metabolic syndrome is highly prevalent in renal transplant recipients and closely
associated with insulin resistance. The prominent criterion of metabolic syndrome in patients seems to be
hypertension, especially high systolic blood pressure. The identification of metabolic syndrome as a risk
factor may yield new treatment modalities to prevent it. Copyright © 2013 Elsevier Inc. All rights reserved.
0 (Blood Glucose). 0 (Glycated Hemoglobin A). 0 (Lipids). 0 (hemoglobin A1c protein, human).
Publication Type
Journal Article.
Year of Publication
2013

<172>
Unique Identifier
24029252
Title
New-onset diabetes after transplantation--role of oral glucose tolerance test for diagnosis and study of risk
factors.
Source
Saudi Journal of Kidney Diseases & Transplantation. 24(5):897-902, 2013 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Sahay M; Sahay RK; Narayan G; Anuradha.
Authors Full Name
Sahay, Manisha; Sahay, Rakesh K; Narayan, Girish; Anuradha.
Institution
Sahay, Manisha. Department of Nephrology, Osmania General Hospital, Hyderabad, Andhra Pradesh,
India. drmanishasahay@rediffmail.com
Comments
Page 104
Comment in (CIN)
Comment in (CIN)
Adolescent
Adrenal Cortex Hormones/ad [Administration & Dosage]
Adult
Cyclosporine/ad [Administration & Dosage]
*Diabetes Mellitus, Type 2/ep [Epidemiology]
Female
*Glucose Tolerance Test
Humans
Insulin Resistance
Male
Middle Aged
Prospective Studies
Risk Factors
Transplantation, Homologous
Young Adult
Abstract
To determine the role of the oral glucose tolerance test in the early detection of new-onset diabetes after
transplantation (NODAT) and to compare the various risk factors and insulin kinetics in the transplant
patients, we studied 41 live-related renal allograft recipients who were not diabetic before transplantation.
Immunosuppression included triple drug therapy (cyclosporine, azathioprine and steroids) and rejection
episodes were treated with methyl prednisolone (30 mg/kg IV x 3 days). All the study patients were
subjected to an oral glucose tolerance test (OGTT) at Day 90 post-transplant and classified as having
normal glucose tolerance (NGT), impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and
NODAT as per the World Health Organization guidelines. Insulin levels were also determined at 0, 1/2
hour, 1 hour and 2 hours during OGTT. NODAT was noted in 29.2% of the study patients, IFG in 4.8% of
the study patients and NGT in 65.8% of the study patients. All the groups had normal fasting plasma
glucose, but higher than normal insulin levels, suggesting insulin resistance. The patients with overt
NODAT had, in addition, low fasting insulin (insulin secretory defect). OGTT may be used for the early
detection of NODAT. Although insulin resistance is detected in the majority of post-transplant patients,
NODAT also reveals also an insulin secretory defect.
0 (Adrenal Cortex Hormones). 0 (Blood Glucose). 0 (Immunosuppressive Agents). 83HN0GTJ6D
(Cyclosporine).
Publication Type
Journal Article.
Year of Publication
2013

<173>
Unique Identifier
23914825
Title
Not seeing does not equal absent-acceptance of live kidney donors with metabolic syndrome.
Page 105
Source
American Journal of Transplantation. 13(9):2241-2, 2013 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Doshi MD.
Authors Full Name
Doshi, M D.
Institution
Doshi, M D. Division of Nephrology, Department of Internal Medicine, Wayne State University, Detroit,
MI.
Comments
Comment on (CON)
Female
Humans
*Kidney/pa [Pathology]
*Kidney/ph [Physiology]
*Living Donors
Male
Publication Type
Editorial. Comment.
Year of Publication
2013

<174>
Unique Identifier
23911219
Title
Adiposity and cardiovascular disease risk factors in renal transplant recipients: Are there differences
between sexes?.
Source
Nutrition. 29(10):1231-6, 2013 Oct.
VI 1
Record Owner
Status
MEDLINE
Authors
Fernandes JF; Leal PM; Rioja S; Bregman R; Sanjuliani AF; Barreto Silva MI; Torres MR.
Authors Full Name
Fernandes, Julia Freitas Rodrigues; Leal, Priscila Mansur; Rioja, Suzimar; Bregman, Rachel; Sanjuliani,
Antonio Felipe; Barreto Silva, Maria Ines; Torres, Marcia Regina Simas Goncalves.
Institution
Page 106
Fernandes, Julia Freitas Rodrigues. Discipline of Clinical and Experimental Pathophysiology, Rio de
Janeiro State University, Rio de Janeiro, Brazil.
Adipose Tissue
*Adiposity
Body Mass Index
*Cardiovascular Diseases/ep [Epidemiology]
Dyslipidemias/ep [Epidemiology]
Female
Humans
Male
Middle Aged
*Obesity, Abdominal/ep [Epidemiology]
*Overweight/ep [Epidemiology]
Prevalence
Risk Factors
Sex Factors
Waist Circumference
Weight Gain
Keyword Heading
Abdominal adiposity
Cardiovascular disease risk factors
Obesity
Overweight
Renal transplantation
Abstract
OBJECTIVE: The aim of this study was to evaluate high body adiposity and cardiovascular disease
(CVD) risk factors prevalence, in renal transplant recipients (RTR), comparing men with women.
METHODS: In this retrospective cross-sectional study, 102 patients (55 men) who were 49 +/- 1.2 y and
114.3 +/- 9 mo post-transplant (post-tx) were evaluated. Pretransplant (pre-tx) period data and weight gain
during the first year post-tx were obtained from patient charts and post-tx data were collected during a
routine visit at nephrology clinic. Body mass index (BMI) >= 25 kg/m(2) defined overweight and BMI >=
30 kg/m(2) defined obesity.
RESULTS: Pre-tx overweight prevalence was low and similar between men and women (26%), whereas
only women showed obesity (11%). Post-tx body weight increased significantly in the entire group, leading
to an increase in overweight (to 38% in men and 51% in women) and obesity (to 11% in men and 23% in
women) prevalence. Post-tx comparisons between men and women showed that women had higher
(women versus men; P < 0.05) BMI values (26.7 +/- 0.8 versus 24.7 +/- 0.5 kg/m(2)), weight gain during
first year post-tx (9.2 +/- 1.1 versus 5.5 +/- 1 kg), abdominal obesity (57% versus 23%) and diabetes (34%
versus 16%) prevalence. The associations between adiposity and CVD risk factors showed that pre-tx
overweight increased the risk for diabetes in post-tx; pos-tx high BMI and abdominal obesity increased the
risk for metabolic syndrome; abdominal obesity increased the risk for dyslipidemia in women.
CONCLUSIONS: High body adiposity prevalence was high after transplantation and increased the risk
for metabolic syndrome, an important CVD risk factor. Women showed higher total body adiposity values,
abdominal obesity, and diabetes prevalence than men. Abdominal obesity increased the risk for
dyslipidemia in women. Copyright © 2013 Elsevier Inc. All rights reserved.
Publication Type
Page 107
Year of Publication
2013

<175>
Unique Identifier
23865821
Title
Association of metabolic syndrome with kidney function and histology in living kidney donors.
Source
American Journal of Transplantation. 13(9):2342-51, 2013 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Ohashi Y; Thomas G; Nurko S; Stephany B; Fatica R; Chiesa A; Rule AD; Srinivas T; Schold JD;
Navaneethan SD; Poggio ED.
Authors Full Name
Ohashi, Y; Thomas, G; Nurko, S; Stephany, B; Fatica, R; Chiesa, A; Rule, A D; Srinivas, T; Schold, J D;
Navaneethan, S D; Poggio, E D.
Institution
Ohashi, Y. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute,
Cleveland Clinic, Cleveland, OH.
Comments
Comment in (CIN)
Adult
Female
Humans
Kidney/ah [Anatomy & Histology]
*Kidney/pa [Pathology]
*Kidney/ph [Physiology]
Life Style
*Living Donors
Male
Middle Aged
Nephrectomy
Prevalence
Weight Loss
Keyword Heading
Body mass index
kidney transplant
living donor
metabolic syndrome
nephrosclerosis
Page 108
outcomes
Abstract
The selection of living kidney donors is based on a formal evaluation of the state of health. However, this
spectrum of health includes subtle metabolic derangements that can cluster as metabolic syndrome. We
studied the association of metabolic syndrome with kidney function and histology in 410 donors from 2005
to 2012, of whom 178 donors were systematically followed after donation since 2009. Metabolic syndrome
was defined as per the NCEP ATPIII criteria, but using a BMI > 25 kg/m(2) instead of waist
circumference. Following donation, donors received counseling on lifestyle modification. Metabolic
syndrome was present in 50 (12.2%) donors. Donors with metabolic syndrome were more likely to have
chronic histological changes on implant biopsies than donors with no metabolic syndrome (29.0% vs.
9.3%, p < 0.001). This finding was associated with impaired kidney function recovery following donation.
At last follow-up, reversal of metabolic syndrome was observed in 57.1% of donors with predonation
metabolic syndrome, while only 10.8% of donors developed de novo metabolic syndrome (p < 0.001). In
conclusion, metabolic syndrome in donors is associated with chronic histological changes, and
nephrectomy in these donors was associated with subsequent protracted recovery of kidney function.
Importantly, weight loss led to improvement of most abnormalities that define metabolic syndrome. ©
Copyright 2013 The American Society of Transplantation and the American Society of Transplant
Surgeons.
Publication Type
Year of Publication
2013

<176>
Unique Identifier
23751485
Title
Metabolic syndrome, vitamin D deficiency and hypoadiponectinemia among nondiabetic patients early
Source
American Journal of Nephrology. 37(5):399-404, 2013.
VI 1
Record Owner
Status
MEDLINE
Authors
Kulshrestha S; Ojo AO; Luan FL.
Authors Full Name
Kulshrestha, Satyarth; Ojo, Akinlolu O; Luan, Fu L.
Institution
Kulshrestha, Satyarth. Division of Nephrology, Department of Internal Medicine, University of Michigan,
Ann Arbor, MI, USA.
Adiponectin/bl [Blood]
*Adiponectin/df [Deficiency]
Adult
Female
Humans
Page 109
Male
*Metabolism, Inborn Errors/co [Complications]
Middle Aged
Prospective Studies
Vitamin D/bl [Blood]
*Vitamin D Deficiency/co [Complications]
Abstract
BACKGROUND AND AIMS: Metabolic syndrome (MetS) is common among kidney transplant patients.
We studied the relationship between MetS, vitamin D deficiency/insufficiency and hypoadiponectinemia
early posttransplantation and their impact on clinical outcomes.
METHODS: Seventy-four previously nondiabetic kidney transplant patients were enrolled in a

prospective cohort study between February and November 2008. Participants underwent a 2-hour oral
glucose tolerance test and had their plasma levels of 25-hydroxyvitamin D (25[OH]D), adiponectin, insulin,
intact parathyroid hormone and lipids measured at 11 weeks posttransplantation. Clinical events including
cardiovascular events, new-onset diabetes after transplantation, acute rejection, graft loss and death were
recorded during the follow-up to December 2012.
RESULTS: Thirty-four study patients (45.9%) had MetS. Patients with MetS had lower plasma
concentrations of 25[OH]D (20.5 +/- 7.2 vs. 24.8 +/- 11.1 ng/ml, p = 0.049) and adiponectin (8.2 +/- 4.5 vs.
14.6 +/- 8.0 mug/ml, p < 0.0001) early on, and higher composite clinical event rate (61.8 vs. 27.5%, p =
0.003) during the follow-up. Multivariate analysis showed that the presence of MetS early after
transplantation was independently associated with 25[OH]D deficiency/insufficiency (OR: 14.0, 95% CI:
1.8, 107.5; p = 0.011), depressed plasma adiponectin levels (beta -6.39, r(2) 0.195, p < 0.0001) and
increased risk for clinical events (OR: 5.6, 95% CI: 1.9, 16.5; p = 0.002).
CONCLUSION: Kidney transplant patients with MetS early after transplantation had lower levels of
25[OH]D and adiponectin, and unfavorable clinical outcomes. Copyright © 2013 S. Karger AG, Basel.
0 (Adiponectin). 1406-16-2 (Vitamin D).
Rare Disease Supplementary Concept
Hypoadiponectinemia
Publication Type
Year of Publication
2013

<177>
Unique Identifier
23726614
Title
Glucose intolerance is associated with increased intimal-medial thickness of the carotid artery and
increased pulse-wave velocity in renal transplant recipients.
Source
Transplantation Proceedings. 45(4):1535-9, 2013 May.
Page 110
VI 1
Record Owner
Status
MEDLINE
Authors
Uchida J; Machida Y; Iwai T; Kuwabara N; Kabei K; Naganuma T; Kumada N; Nakatani T.
Authors Full Name
Uchida, J; Machida, Y; Iwai, T; Kuwabara, N; Kabei, K; Naganuma, T; Kumada, N; Nakatani, T.
Institution
Uchida, J. Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
m9492120@msic.med.osaka-cu.ac.jp
Aged
*Carotid Arteries/pa [Pathology]
Female
*Glucose Tolerance Test
Humans
Islets of Langerhans/pp [Physiopathology]
Male
Middle Aged
*Pulse Wave Analysis
*Tunica Intima/pa [Pathology]
Abstract
BACKGROUND: Although new-onset diabetes after transplantation has been demonstrated to have a
significant negative impact on allograft and patient survival, the role of glucose intolerance (impaired
fasting glucose [IFG] and/or impaired glucose tolerance [IGT], as asymptomatic hyperglycemia and
borderline diabetes, has not been identified in renal transplant recipients.
METHODS: We enrolled 32 renal transplant recipients (at least 1 year after transplantation) without prior
evidence of diabetes at our institution in this study. Transplant recipients were divided into 2 groups
(normal glucose tolerance group and glucose intolerance group) according to the results of their oral
glucose tolerance test with 75 g of glucose. Glucose intolerance included IFG, IGT, and IFG/IGT. Normal
glucose tolerance was detected in 19 patients, and glucose intolerance in 13: had 6 IGT, 2 IFG, and 5
IGT/IFG. Bilateral brachial-ankle pulse-wave velocity (baPWV) and intimal-media thickness (IMT)
measured as markers of atherosclerosis were compared between the 2 groups. Insulin resistance was
estimated with the homeostasis model assessment of insulin resistance (HOMA-R), and pancreatic beta-cell
function evaluated by the homeostasis model assessment of beta-cell function and insulinogenic index.
RESULTS: The patients in the glucose intolerance group showed significantly greater baPWV and IMT
than those in the normal glucose tolerance group. HOMA-R in the glucose intolerance patients was
significantly higher than in the normal glucose tolerance patients. Linear regression analysis showed the
increased IMT in the renal transplant recipients to be significantly correlated with HOMA-R.
CONCLUSIONS: Renal transplant recipients with glucose intolerance had increased IMT and baPWV,
suggesting that glucose intolerance in renal transplant recipients may induce atherosclerosis and that the
rise in insulin resistance may contribute to the increased IMT in renal transplant recipients. Copyright ©
2013 Elsevier Inc. All rights reserved.
Publication Type
Journal Article.
Year of Publication
2013
Page 111
<178>
Unique Identifier
23634804
Title
Diagnosis, management and treatment of glucometabolic disorders emerging after kidney transplantation:
a position statement from the Nordic Transplantation Societies. [Review]
Source
Transplant International. 26(11):1049-60, 2013 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Hornum M; Lindahl JP; von Zur-Muhlen B; Jenssen T; Feldt-Rasmussen B.
Authors Full Name
Hornum, Mads; Lindahl, Jorn P; von Zur-Muhlen, Bengt; Jenssen, Trond; Feldt-Rasmussen, Bo.
Institution
Hornum, Mads. Department of Nephrology, Copenhagen University Hospital Rigshospitalet,
Adult
Cardiovascular Diseases/pc [Prevention & Control]
Humans
*Hyperglycemia/co [Complications]
Hyperglycemia/di [Diagnosis]
Hypoglycemic Agents/tu [Therapeutic Use]
Insulin/tu [Therapeutic Use]
Insulin Resistance
Middle Aged
Risk Factors
Keyword Heading
immunosuppression
new-onset diabetes mellitus
transplantation
treatment
Abstract
After successful solid organ transplantation, new-onset diabetes (NODAT) is reported to develop in about
15-40% of the patients. The variation in incidence may partly depend on differences in the populations that
have been studied and partly depend on the different definitions of NODAT that have been used. The
diagnosis was often based on 'the use of insulin postoperatively', 'oral agents used', random glucose
monitoring and a fasting glucose value between 7 and 13 mmol/l (126-234 mg/dl). Only few have used a 2-
h glucose tolerance test performed before transplantation. There is a huge variation in the literature
regarding risk factors for developing NODAT. They can be divided into factors related to glucose
metabolism or to patient demographics and the latter into modifiable and nonmodifiable. Screening for risk
factors should start early and be re-evaluated while being on the waitlist. Patients on the waiting list for
renal transplantation and transplanted patients share many characteristics in having hyperglycaemia,
Page 112
disturbed insulin secretion and increased insulin resistance. We present guidelines for early risk factor
assessment and a screening/treatment strategy for disturbed glucose metabolism, both before and after
transplantation. The aim was to avoid the increased cardiovascular disease and mortality rates associated
with NODAT. Copyright © 2013 Steunstichting ESOT. Published by John Wiley & Sons Ltd.
0 (Hypoglycemic Agents). 0 (Insulin).
Publication Type
Journal Article. Practice Guideline. Review.
Year of Publication
2013

<179>
Unique Identifier
23613600
Title
Can new-onset diabetes after kidney transplant be prevented?. [Review]
Source
Diabetes Care. 36(5):1406-12, 2013 May.
VI 1
Record Owner
Status
MEDLINE
Authors
Chakkera HA; Weil EJ; Pham PT; Pomeroy J; Knowler WC.
Authors Full Name
Chakkera, Harini A; Weil, E Jennifer; Pham, Phuong-Thu; Pomeroy, Jeremy; Knowler, William C.
Institution
Chakkera, Harini A. Division of Transplantation, Mayo Clinic, Phoenix, AZ, USA.
chakkera.harini@mayo.edu
Comments
Comment in (CIN)
Comment in (CIN)
Diabetes Mellitus, Type 2/me [Metabolism]
Humans
Insulin/tu [Therapeutic Use]
Insulin-Secreting Cells/de [Drug Effects]
Abstract
Because the negative consequences of new-onset diabetes mellitus after transplantation (NODAT)
diminish the significant gains of kidney transplantation, it is imperative to develop clinical interventions to
reduce the incidence of NODAT. In this review, we discuss whether intensive lifestyle interventions that
delay or prevent type 2 diabetes mellitus may decrease the incidence of NODAT. We examine the literature
pertaining to incidence and timing of onset of NODAT, as well as the risk factors and pathophysiology that
NODAT shares with type 2 diabetes mellitus, namely pathways related to increased insulin resistance and
decreased insulin secretion. Our central hypothesis is that NODAT results from the same metabolic risk
factors that underlie type 2 diabetes mellitus. These risk factors are altered and enhanced by transplantation,
Page 113
"tipping" some transplant recipients with seemingly normal glucose homeostasis before transplant toward
the development of NODAT. We describe the diabetogenic properties of transplant immunosuppressive
drugs. We describe novel methods of prevention that are being explored, including resting the pancreatic
beta-cells by administration of basal insulin during the period immediately after transplant. On the basis of
the current evidence, we propose that intensive lifestyle modification, adapted for individuals with chronic
kidney disease or end-stage renal disease, as well as resting pancreatic beta-cells during the immediate
postoperative period, may lower the incidence of NODAT.
0 (Insulin).
Publication Type
Year of Publication
2013

<180>
Unique Identifier
23483365
Title
Obesity and metabolic syndrome in kidney transplantation. [Review]
Source
Current Hypertension Reports. 15(3):215-23, 2013 Jun.
VI 1
Record Owner
Status
MEDLINE
Authors
LaGuardia H; Zhang R.
Authors Full Name
LaGuardia, Heather; Zhang, Rubin.
Institution
LaGuardia, Heather. Tulane Abdominal Transplant Institute, Section of Nephrology Department of
Medicine, Tulane University School of Medicine, 1430 Tulane Ave, SL-45, New Orleans, LA 70112, USA.
hlaguar@tulane.edu
Animals
Humans
*Obesity/co [Complications]
Risk Factors
Abstract
The epidemic of obesity and metabolic syndrome (MS) contributes to the rapid growth of chronic kidney
disease (CKD) and end-stage renal disease (ESRD). There is a reverse epidemiology, known as the
Page 114
"obesity paradox," in ESRD patients receiving maintenance dialysis. Obese patients are routinely referred
for kidney transplant, and they have more surgical and medical complications than non-obese patients.
However, compared to dialysis, kidney transplant provides a survival benefit for obese patients. After
kidney transplant, obese patients tend to gain more body weight, and non-obese patients can develop new-
onset obesity/MS. Obesity/MS is not only associated with serious morbidities, but also compromises the
long-term graft and patient survival. The immunosuppressive drugs commonly used as maintenance
therapy, including corticosteroids, calcineurin inhibitors and mammalian target-of-rapamycin inhibitors,
contribute to obesity/MS. Development of novel immunosuppressive drugs free of metabolic adverse
effects is needed, so that the full potential and benefits of kidney transplantation can be realized.
Publication Type
Year of Publication
2013

<181>
Unique Identifier
23391995
Title
Longitudinal analysis of vascular function and biomarkers of metabolic bone disorders before and after
renal transplantation.
Source
American Journal of Nephrology. 37(2):126-34, 2013.
VI 1
Record Owner
Status
MEDLINE
Authors
Yilmaz MI; Sonmez A; Saglam M; Yaman H; Kilic S; Turker T; Unal HU; Gok M; Cetinkaya H; Eyileten
T; Oguz Y; Caglar K; Vural A; Mallamaci F; Zoccali C.
Authors Full Name
Yilmaz, Mahmut Ilker; Sonmez, Alper; Saglam, Mutlu; Yaman, Halil; Kilic, Selim; Turker, Turker; Unal,
Hilmi Umut; Gok, Mahmut; Cetinkaya, Hakki; Eyileten, Tayfun; Oguz, Yusuf; Caglar, Kayser; Vural,
Abdulgaffar; Mallamaci, Francesca; Zoccali, Carmine.
Institution
Yilmaz, Mahmut Ilker. Department of Nephrology, Gulhane School of Medicine, Ankara, Turkey.
mahmutiyilmaz@yahoo.com
Adult
*Blood Vessels/pp [Physiopathology]
Bone Diseases, Metabolic/bl [Blood]
Bone Diseases, Metabolic/et [Etiology]
Dilatation, Pathologic/et [Etiology]
Dilatation, Pathologic/pp [Physiopathology]
Female
*Fibroblast Growth Factors/bl [Blood]
Humans
Page 115
Male
*Phosphates/bl [Blood]
Renal Insufficiency, Chronic/co [Complications]
Renal Insufficiency, Chronic/su [Surgery]
*Vitamin D/aa [Analogs & Derivatives]
Vitamin D/bl [Blood]
Young Adult
Abstract
BACKGROUND/AIMS: The role of chronic kidney disease-mineral bone disorder (CKD-MBD)
reversibility in the amelioration of vascular function and in the reduction of the risk for cardiovascular
events after renal transplantation is still unknown.
METHODS: We investigated the longitudinal relationship between the main biomarkers of CKD-MBD
and the evolution of vascular function [flow-mediated dilatation (FMD)] after transplantation in a series of
161 patients with kidney failure maintained on chronic dialysis (5D-CKD).
RESULTS: Before transplantation, FMD in patients was markedly lower (-40%, p < 0.001) than in well-
matched healthy subjects and increased by 27% after transplantation (p = 0.001). Fibroblast growth factor
23 (FGF23), 25-hydroxy-vitamin D (25OHVD) and serum phosphate (p < 0.01) were independently
associated with simultaneous changes in FMD. Changes in classical risk factors and in risk factors related
to CKD like the glomerular filtration rate, serum albumin, C-reactive protein and insulin resistance failed to
independently explain the variability in FMD changes after transplantation.
CONCLUSION: Endothelium-dependent vasodilatation improves after kidney transplantation, which is

parallel to the dramatic fall in FGF23, the reduction in serum phosphorus and the increase in 25OHVD
levels. If these associations are causal, a part of decline in cardiovascular risk after transplantation is related
to partial resolution of CKD-MBD. Copyright © 2013 S. Karger AG, Basel.
0 (Biomarkers). 0 (Phosphates). 1406-16-2 (Vitamin D). 62031-54-3 (Fibroblast Growth Factors).
7Q7P4S7RRE (fibroblast growth factor 23). A288AR3C9H (25-hydroxyvitamin D).
Publication Type
Journal Article.
Year of Publication
2013

<182>
Unique Identifier
23283133
Title
The adipose tissue production of adiponectin is increased in end-stage renal disease.
Source
Kidney International. 83(3):487-94, 2013 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Page 116
Martinez Cantarin MP; Waldman SA; Doria C; Frank AM; Maley WR; Ramirez CB; Keith SW; Falkner
B.
Authors Full Name
Martinez Cantarin, Maria P; Waldman, Scott A; Doria, Cataldo; Frank, Adam M; Maley, Warren R;
Ramirez, Carlo B; Keith, Scott W; Falkner, Bonita.
Institution
Martinez Cantarin, Maria P. Department of Pharmacology and Experimental Therapeutics, Thomas
Jefferson University, Philadelphia, Pennsylvania 19107, USA. maria.p.martinez@jefferson.edu
*Adiponectin/bi [Biosynthesis]
Adiponectin/ge [Genetics]
*Adipose Tissue/me [Metabolism]
Adult
Aged
Cardiovascular Diseases/et [Etiology]
Female
Humans
*Kidney Failure, Chronic/me [Metabolism]
Male
Middle Aged
RNA, Messenger/an [Analysis]
Receptors, Adiponectin/an [Analysis]
Abstract
Adiponectin has antidiabetic properties, and patients with obesity, diabetes, and insulin resistance have
low plasma adiponectin levels. However, although kidney disease is associated with insulin resistance,
adiponectin is elevated in end-stage renal disease. Here we determine whether adipose tissue production of
adiponectin is increased in renal disease in a case-control study of 36 patients with end-stage renal disease
and 23 kidney donors. Blood and tissue samples were obtained at kidney transplantation and donation. The
mean plasma adiponectin level was significantly increased to 15.6 mg/ml in cases compared with 8.4
mg/ml in controls. Plasma levels of the inflammatory adipokines tumor necrosis factor alpha, interleukin 6,
and high-sensitivity C-reactive protein were significantly higher in cases compared with controls.
Adiponectin mRNA and protein expression in visceral and subcutaneous fat were significantly higher in
cases than controls, while adiponectin receptor-1 mRNA expression was significantly increased in
peripheral blood cells, muscle, and adipose tissue in cases compared with controls. Thus, our study
suggests that adipose tissue production of adiponectin contributes to the high plasma levels seen in end-
stage renal disease.
0 (ADIPOR1 protein, human). 0 (ADIPOR2 protein, human). 0 (Adiponectin). 0 (RNA, Messenger). 0
(Receptors, Adiponectin).
Publication Type
Year of Publication
2013

<183>
Unique Identifier
23230898
Title
Page 117
Role of insulin resistance indices in predicting new-onset diabetes after kidney transplantation.
Source
Transplant International. 26(3):273-80, 2013 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Nagaraja P; Ravindran V; Morris-Stiff G; Baboolal K.
Authors Full Name
Nagaraja, Pramod; Ravindran, Vinod; Morris-Stiff, Gareth; Baboolal, Kesh.
Institution
Nagaraja, Pramod. Nephrology and Transplantation Directorate, University Hospital of Wales, Cardiff
CF14 4XW, UK. npramod@doctors.net.uk
Cyclosporins/ad [Administration & Dosage]
Diabetes Mellitus/mo [Mortality]
Female
Follow-Up Studies
Graft Rejection
Graft Survival
Humans
*Immunosuppressive Agents/ad [Administration & Dosage]
*Insulin Resistance
*Kidney Transplantation/mo [Mortality]
Logistic Models
Male
Postoperative Complications/mo [Mortality]
Prospective Studies
Risk Assessment
Survival Analysis
Tacrolimus/ad [Administration & Dosage]
Time Factors
Transplantation Immunology
Treatment Outcome
Abstract
New-onset diabetes mellitus (NODAT) is a serious complication following renal transplantation. In this
cohort study, we studied 118 nondiabetic renal transplant recipients to examine whether indices of insulin
resistance and secretion calculated before transplantation and at 3 months post-transplantation are
associated with the development of NODAT within 1 year. We also analysed the long-term impact of early
diagnosed NODAT. Insulin indices were calculated using homeostasis model assessment (HOMA) and
McAuley's Index. NODAT was diagnosed using fasting plasma glucose. Median follow-up was 11 years.
The cumulative incidence of NODAT at 1 year was 37%. By logistic regression, recipient age (per year)
Page 118
was the only significant pretransplant predictor of NODAT (OR 1.04, CI 1.009-1.072), while age (OR 1.04,
CI 1.005-1.084) and impaired fasting glucose (OR 2.97, CI 1.009-8.733) were significant predictors at 3
months. Pretransplant and 3-month insulin resistance and secretion indices did not predict NODAT. All-
cause mortality was significantly higher in recipients developing NODAT within 1 year compared with
those remaining nondiabetic (44% vs. 22%, log-rank P = 0.008). By Cox's regression analysis, age (HR
1.075, CI 1.042-1.110), 1-year creatinine (HR 1.007, CI 1.004-1.010) and NODAT within 3 months (HR
2.4, CI 1.2-4.9) were independent predictors of death. In conclusion, NODAT developing early after renal
transplantation was associated with poor long-term patient survival. Insulin indices calculated
pretransplantation using HOMA and McAuley's Index did not predict NODAT. Copyright © 2012 The
Authors Transplant International © 2012 European Society for Organ Transplantation. Published by
Blackwell Publishing Ltd.
0 (Blood Glucose). 0 (Cyclosporins). 0 (Immunosuppressive Agents). WM0HAQ4WNM (Tacrolimus).
Publication Type
Comparative Study. Journal Article. Randomized Controlled Trial.
Year of Publication
2013

<184>
Unique Identifier
23195004
Title
Combination of epidural anesthesia and general anesthesia attenuates stress response to renal
transplantation surgery.
Source
Transplantation Proceedings. 44(10):2949-54, 2012 Dec.
VI 1
Record Owner
Status
MEDLINE
Authors
Hadimioglu N; Ulugol H; Akbas H; Coskunfirat N; Ertug Z; Dinckan A.
Authors Full Name
Hadimioglu, N; Ulugol, H; Akbas, H; Coskunfirat, N; Ertug, Z; Dinckan, A.
Institution
Hadimioglu, N. Department of Anesthesiology and Reanimation, Akdeniz University Hospital, Antalya,
Turkey. necmiye@akdeniz.edu.tr
Adult
*Anesthesia, Epidural
*Anesthesia, General
Female
Humans
Inflammation/bl [Blood]
Inflammation/pc [Prevention & Control]
Inflammation Mediators/bl [Blood]
Page 119
Insulin/bl [Blood]
Insulin Resistance
Interleukin-6/bl [Blood]
Length of Stay
Male
Postoperative Complications/im [Immunology]
Postoperative Complications/pp [Physiopathology]
*Postoperative Complications/pc [Prevention & Control]
Prospective Studies
Resistin/bl [Blood]
*Stress, Physiological
Time Factors
Treatment Outcome
Tumor Necrosis Factor-alpha/bl [Blood]
Turkey
Abstract
Choice of the anesthestic technique can reduce or even eliminate stress responses to surgery and decrease
the incidence of complications. Our aim was to compare a combination of epidural anesthesia+general
anesthesia with general anesthesia alone as regards perioperative insulin resistance and inflammatory
activation among renal transplant recipients. Forty-six nondiabetic patients undergoing renal transplantation
were prospectively randomized to the epidural anesthesia + general anesthesia group (n = 21), or general
anesthesia alone group (n = 25). Plasma levels of glucose, insulin, interleukin (IL)-6, tumour necrosis factor
(TNF)-alpha, resistin, and adiponectin were measured at baseline (T1), end of surgery (T2), postoperative
first hour (T3), postoperative second hour (T4) and postoperative 24th hour (T5). Homeostasis model
assessment-estimated insulin resistance (HOMA-IR) scores were calculated at every time point that the
blood samples were collected. Glucose levels (P < .001) and insulin levels at the end of surgery (P = .048)
and at postoperative first hour (P = .005) and HOMA-IR levels at the end of surgery (P = .012) and at
postoperative first hour (P = .010) showed significantly higher values among the general anesthesia alone
group when compared with the epidural+general anesthesia group. TNF-alpha levels at postoperative 2nd
and at 24th hour (P = .005 and P = .004, respectively) and IL-6 levels at postoperative 1st and 2nd hours (P
= .002 and P = .045, respectively) were significantly higher in the general anesthesia alone group when
compared with the epidural+general anesthesia group. The TNF-alpha levels were significantly less at all
time points when compared with baseline only in the epidural+general anesthesia group (T1, 33.36 vs
37.25; T2, 18.45 vs 76.52; T3, 15.18 vs 78.27; T4, 10.75 vs 66.64; T5, 2.98 vs 36.32) Hospital stays were
significantly shorter among the epidural+general anesthesia group (P = .022). We showed partly attenuated
surgical stress responses among patients undergoing renal transplantation using general anesthesia
combined with epidural anesthesia compared with general anesthesia alone. Copyright © 2012 Elsevier Inc.
0 (ADIPOQ protein, human). 0 (Adiponectin). 0 (Biomarkers). 0 (Blood Glucose). 0 (IL6 protein,
human). 0 (Inflammation Mediators). 0 (Insulin). 0 (Interleukin-6). 0 (RETN protein, human). 0 (Resistin).
0 (Tumor Necrosis Factor-alpha).
Publication Type
Comparative Study. Journal Article. Randomized Controlled Trial.
Year of Publication
2012

Page 120
<185>
Unique Identifier
22994569
Title
Plasma adiponectin before and after kidney transplantation.
Source
Transplant International. 25(11):1194-203, 2012 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Idorn T; Hornum M; Bjerre M; Jorgensen KA; Nielsen FT; Hansen JM; Flyvbjerg A; Feldt-Rasmussen B.
Authors Full Name
Idorn, Thomas; Hornum, Mads; Bjerre, Mette; Jorgensen, Kaj Anker; Nielsen, Finn Thomsen; Hansen,
Jesper Melchior; Flyvbjerg, Allan; Feldt-Rasmussen, Bo.
Institution
Idorn, Thomas. Department of Nephrology, Copenhagen University Hospital, Rigshospitalet,
Copenhagen, Denmark. thomas.idorn@rh.regionh.dk
Adult
Female
Humans
Insulin Resistance
Male
Middle Aged
Uremia/bl [Blood]
Abstract
The role of plasma adiponectin (ADPN) in patients with impaired kidney function and following kidney
transplantation (Tx) is debated. We aimed to: (i) determine whether pretransplant ADPN level is an
independent risk factor for deterioration of glucose tolerance including development of new-onset diabetes
mellitus after Tx, (ii) describe which parameters that influence the ADPN concentration before and after
Tx. Fifty-seven nondiabetic kidney allograft recipients and 40 nondiabetic uraemic patients were included.
The Tx group was examined at baseline and 3 and 12 months after Tx. The uraemic control group was
examined twice, separated by 12 months. ADPN levels declined significantly following Tx (P < 0.0001),
while estimated glomerular filtration rate (eGFR) increased (P < 0.0005). eGFR, BMI and insulin
sensitivity index were independently associated with ADPN in a multivariate regression analysis, whereas
an ordinal logistic regression analysis revealed no predictive characteristic of ADPN for aggravation of the
glucose tolerance after Tx. In conclusion, kidney transplantation is accompanied by a significant reduction
in ADPN concentration. Several factors determine the ADPN concentration before and after Tx including
kidney function, insulin resistance, use of immunosuppressive agents and BMI. Pretransplant ADPN level
did not predict development of new-onset diabetes mellitus or even deterioration of the glucose tolerance
following Tx. Copyright © 2012 The Authors. Transplant International © 2012 European Society for
Organ Transplantation.
0 (Adiponectin).
Publication Type
Year of Publication
2012
Page 121
<186>
Unique Identifier
22974866
Title
Cardiovascular risk factors in renal transplant patients after switch from standard tacrolimus to prolonged-
release tacrolimus.
Source
Transplantation Proceedings. 44(7):1901-6, 2012 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Sessa A; Esposito A; Iavicoli G; Lettieri E; Ragosta G; Rossano R; Capuano M.
Authors Full Name
Sessa, A; Esposito, A; Iavicoli, G; Lettieri, E; Ragosta, G; Rossano, R; Capuano, M.
Institution
Sessa, A. Day Hospital Post-trapianto Rene, UOC Nefrologia e Dialisi, Napoli, Italy.
dhtr.pellegrini@libero.it
Adult
Aged
Delayed-Action Preparations
Female
Humans
Male
Middle Aged
Risk Factors
Tacrolimus/ad [Administration & Dosage]
Abstract
Cardiovascular (CV) diseases are the leading cause of death after renal transplantation. Renal transplant
patients present CV risk factors that correlate with renal function and the use of immunosuppressive drugs.
Noncompliance with immunosuppressive therapy after organ transplantation increases the incidence of
rejection, graft loss, and patient death. A simple posology regimen is the best way to promote compliance
with prescribed therapy. To meet this need, a new formulation of tacrolimus that is suitable for once-daily
administration, is now available on the market: prolonged-release tacrolimus (Fkpr). We analyzed changes
in CV risk factors observed in renal transplant patients after transition from standard tacrolimus (Fk) to
Fkpr and the rate of patients with the investigated parameters within the normal ranges before and after
conversion. The study enrolled 40 Caucasian renal transplant patients (26 men and 14 women) who were
being followed at our posttransplantation day hospital clinics. After a varying time interval after
transplantation, patients on treatment with tacrolimus, mycophenolate + mofetil (MMF), and steroid
entered a 12-month observation period. Thereafter, they were switched to Fkpr, also in association with
MMF and steroid, and were observed for a further 12-month period. The following parameters were tested
in all patients: creatinine, creatinine clearance, insulin resistance, total cholesterol, HDL cholesterol, LDL
cholesterol, triglycerides, uric acid, homocysteine, and urine magnesium. The switch from Fk to Fkpr
showed an improvement of the parameters investigated. Moreover, the proportion of patients with normal
Page 122
laboratory values after the transition from Fk to Fkpr was noted either to increase or to remain stable at the
improved levels observed during therapy with Fk. Immunosuppressive treatment with Fkpr represents an
even better option than Fk for renal transplant patients, because by reducing CV risk factors it favorably
affects the long-term outcomes for graft and patient. Copyright © 2012 Elsevier Inc. All rights reserved.
0 (Delayed-Action Preparations). WM0HAQ4WNM (Tacrolimus).
Publication Type
Journal Article.
Year of Publication
2012

<187>
Unique Identifier
22967251
Title
Prevalence of the metabolic syndrome in renal transplant recipients.
Source
Arab Journal of Nephrology and Transplantation. 5(3):141-4, 2012 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Elkehili IM; Kekli AB; Grera AM.
Authors Full Name
Elkehili, Ibrahim M; Kekli, Ahmed B; Grera, Ali M.
Institution
Elkehili, Ibrahim M. Nephrology Department, National Heart Center, Tripoli, Libya.
elkhili57im@hotmail.com
Adult
Female
Humans
Male
Middle Aged
Prevalence
Abstract
INTRODUCTION: The cause of the metabolic syndrome (MS) is incompletely understood but represents
a complex interaction between genetic, environmental, and metabolic factors, clearly including diet, and
level of physical activity. The prevalence of MS is continuously increasing in the general population.
Recently it has been found that MS is also common in renal transplant recipients (RTRs). The aim of this
study was to determine the prevalence and characteristics of MS in a group of Libyan renal transplant
recipients, using two different diagnostic criteria.
METHODS: This study was conducted at the Nephrology Department of the National Heart Center,
Tripoli, Libya. We determined the prevalence of MS in a group of renal transplant recipients using both the
Page 123
National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) criteria and the
International Diabetes Federation (IDF) criteria. All patients were more than six months post
transplantation. Patients with Pre-transplant diabetes mellitus were excluded from the analysis.
RESULTS: By using the NCEP-ATP III criteria 26 out of 91 patients (28.6%) had the metabolic
syndrome. MS was commoner in females than males, affecting 12 out of 35 females (34.3%) and 14 out of
56 males (25%). Using the IDF criteria the metabolic syndrome was diagnosed in 23 patients (25.3%). In
this group of patients the most common component of the metabolic syndrome was high blood pressure and
the least common was impaired glucose tolerance and diabetes.
CONCLUSIONS: The prevalence of MS in our renal transplant patients is high, affecting females more
than males. Key words: International Diabetes Federation; Metabolic Syndrome; NCEP-ATP III; Renal
Transplant Recipients.
Publication Type
Journal Article.
Year of Publication
2012

<188>
Unique Identifier
22935845
Title
Dietary acid load and metabolic acidosis in renal transplant recipients.
Source
Clinical Journal of The American Society of Nephrology: CJASN. 7(11):1811-8, 2012 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
van den Berg E; Engberink MF; Brink EJ; van Baak MA; Joosten MM; Gans RO; Navis G; Bakker SJ.
Authors Full Name
van den Berg, Else; Engberink, Marielle F; Brink, Elizabeth J; van Baak, Marleen A; Joosten, Michel M;
Gans, Reinold O B; Navis, Gerjan; Bakker, Stephan J L.
Institution
van den Berg, Else. Top Institute Food and Nutrition, Wageningen, the Netherlands.
e.van.den.berg@umcg.nl
*Acidosis/et [Etiology]
Adult
Aged
Bicarbonates/bl [Blood]
Cardiovascular Diseases/et [Etiology]
Diet
Female
Humans
Hydrogen-Ion Concentration
Page 124
Linear Models
Male
Middle Aged
Abstract
BACKGROUND AND OBJECTIVES: Acidosis is prevalent among renal transplant recipients (RTRs)
and adversely affects cardiometabolic processes. Factors contributing to acidosis are graft dysfunction and
immunosuppressive drugs. Little is known about the potential influence of diet on acidosis in RTRs. This
study examined the association of metabolic acid load with acidosis and with cardiovascular risk factors in
RTRs and aimed to identify dietary factors associated with acidosis. DESIGN, PARTICIPANTS,
SETTING, & MEASUREMENTS: 707 RTRs were included. Metabolic acid load was assessed by
measuring 24-hour urinary net acid excretion (NAE; i.e., titratable acid + ammonium - bicarbonate).
Acidosis was defined as serum [HCO(3)(-)] < 24 mmol/L. BP and insulin resistance, reflected by
hemoglobin A1c, were among cardiovascular risk factors. Diet was assessed with food-frequency
questionnaires. Linear regression analysis was applied to investigate association between NAE and acidosis
and between dietary factors and acidosis.
RESULTS: Mean age +/- SD was 53 +/- 13 years; 57% of patients were male. Acidosis was present in
31% of RTRs. NAE was associated with acidosis (serum HCO(3)(-): beta=-0.61; serum pH: beta=-0.010;
both P<0.001). Patients with high intake of animal protein (i.e., from meat, cheese, and fish) and low intake
of fruits and vegetables had significantly lower serum HCO(3)(-) and serum pH. No associations were
observed between NAE and cardiovascular risk factors, such as hypertension and insulin resistance.
CONCLUSIONS: In addition to conventional factors contributing to acidosis, diet might influence acid-
base homeostasis in RTRs. Higher intake of fruits and vegetables and lower animal protein intake is
associated with less acidosis in RTRs.
0 (Bicarbonates).
Publication Type
Year of Publication
2012

<189>
Unique Identifier
22919275
Title
Insulin resistance in patients with chronic kidney disease. [Review]
Source
Journal of Biomedicine & Biotechnology. 2012:691369, 2012.
VI 1
Record Owner
Status
MEDLINE
Authors
Liao MT; Sung CC; Hung KC; Wu CC; Lo L; Lu KC.
Authors Full Name
Liao, Min-Tser; Sung, Chih-Chien; Hung, Kuo-Chin; Wu, Chia-Chao; Lo, Lan; Lu, Kuo-Cheng.
Institution
Page 125
Liao, Min-Tser. Department of Pediatrics, Taoyuan Armed Forces General Hospital, Taoyuan 325,
Taiwan.
Humans
*Insulin Resistance
*Kidney Failure, Chronic/pa [Pathology]
Models, Biological
Risk Factors
Abstract
Metabolic syndrome and its components are associated with chronic kidney disease (CKD) development.
Insulin resistance (IR) plays a central role in the metabolic syndrome and is associated with increased risk
for CKD in nondiabetic patients. IR is common in patients with mild-to-moderate stage CKD, even when
the glomerular filtration rate is within the normal range. IR, along with oxidative stress and inflammation,
also promotes kidney disease. In patients with end stage renal disease, IR is an independent predictor of
cardiovascular disease and is linked to protein energy wasting and malnutrition. Systemic inflammation,
oxidative stress, elevated serum adipokines and fetuin-A, metabolic acidosis, vitamin D deficiency,
depressed serum erythropoietin, endoplasmic reticulum stress, and suppressors of cytokine signaling all
cause IR by suppressing insulin receptor-PI3K-Akt pathways in CKD. In addition to adequate renal
replacement therapy and correction of uremia-associated factors, thiazolidinedione, ghrelin, protein
restriction, and keto-acid supplementation are therapeutic options. Weight control, reduced daily
prednisolone dosage, and the use of cyclosporin decrease the risk of developing new-onset diabetes after
kidney transplantation. Improved understanding of the pathogenic mechanisms underlying IR in CKD may
lead to more effective therapeutic strategies to reduce uremia-associated morbidity and mortality.
Publication Type
Year of Publication
2012

<190>
Unique Identifier
22794155
Title
Non-infectious complications of immunosuppressant medications in renal transplant patients.
Source
Current Clinical Pharmacology. 7(4):254-62, 2012 Nov.
VI 1
Record Owner
Status
MEDLINE
Authors
Bichu P; Chaudhary K.
Authors Full Name
Bichu, Prasad; Chaudhary, Kunal.
Institution
Bichu, Prasad. Clinical Medicine, Division of Nephrology, University of Missouri - Columbia,
Nephrology Section, Harry S Truman Memorial Veterans Hospital, Columbia, MO 65212, USA.
Page 126
Calcineurin Inhibitors
Coronary Artery Disease/et [Etiology]
Humans
Lymphoproliferative Disorders/et [Etiology]
Abstract
Over the years Renal Transplant has become increasingly successful and fairly routine in terms of
availability to prospective patients. More effective and better tolerated medications have led to decreased
adverse immunologic events after transplant leading to improved graft survival. Moreover, since the last
few years renal transplant is being offered to a wider range of patients with variety of comorbidities, thus
making the surveillance of long term complications of immunosuppression (IS) medications critical for
both graft and patient survival. As the use of newer and more potent medications becomes more wide
spread, their adverse effects, interactions amongst themselves as well as with other medications, are
necessary to recognize and follow closely specially in patients with other comorbidities. Although
infections resulting from IS are common; other noninfectious complications cause significant problems in a
transplant patient. Post-transplant, several preexisting risk factors like hypertension (HTN), dyslipidemia
and hyperglycemia usually get exacerbated resulting in accelerated atherosclerosis causing cardiovascular
disease which is the most common cause of death in transplant patients. Some IS medications have been
implicated as a cause for certain malignancies and their close surveillance and timely intervention is an
important aspect of care for these patients. Therefore an understanding of these medications and their
adverse effects is of paramount importance for the successful medical management of these patients. In this
manuscript we review the transplant IS and systematically outline their various noninfectious adverse
effects.
0 (Calcineurin Inhibitors). 0 (Immunosuppressive Agents).
Publication Type
Journal Article.
Year of Publication
2012

<191>
Unique Identifier
22766888
Title
Metabolic syndrome in transplant patients: an updating point of view. [Review]
Source
Minerva Endocrinologica. 37(3):211-20, 2012 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Sorice GP; Di Pizio L; Sun VA; Schiro T; Muscogiuri G; Mezza T; Cefalo CM; Prioletta A; Pontecorvi
A; Giaccari A.
Authors Full Name
Sorice, G P; Di Pizio, L; Sun, V A; Schiro, T; Muscogiuri, G; Mezza, T; Cefalo, C M A; Prioletta, A;
Pontecorvi, A; Giaccari, A.
Page 127
Institution
Sorice, G P. Division of Endocrinology and Metabolic Diseases, Catholic University, Rome, Italy.
sorice.gianpio@gmail.com
Body Mass Index
Humans
Incidence
Italy/ep [Epidemiology]
Metabolic Syndrome/mo [Mortality]
Renal Insufficiency/su [Surgery]
Risk Factors
Survival Rate
Abstract
Metabolic syndrome (MS) is a cluster of risk factors that predispose to major cardiovascular diseases and
its complications, determining liver and kidney impairment. In the last decade, the indications to
transplantation are increasing, with a linear incidence of the complications of the procedure. MS represents
one of the commonest, being in turn may the consequence of the underlying disease that required the
transplantation, or the result of the medical treatment, as well as one of the most important factor
influencing the morbidity and mortality of the transplanted patients. Due to the growing incidence of the
MS in these patients, it is crucial to focus and clarify the leading causes determining the onset of the
metabolic disarrangement, its outcome and the hypothetical mechanism through which the clinicians could
reduce the impact of the disease. In fact, prevention, early recognition, and treatment of the factor that
could predict the onset or progression of the MS after the transplantation may impact long term survival of
patients, that is again the scope of the same transplant. This review will update the different mechanisMS of
the pathogenesis of MS in this population, the clinical effects of the presence of the MS, observing the risk
factors to be treated before and after the transplantation and suggesting the management of the follow-up.
Publication Type
Year of Publication
2012

<192>
Unique Identifier
22548293
Title
Clinical diagnosis of metabolic syndrome: predicting new-onset diabetes, coronary heart disease, and
allograft failure late after kidney transplant.
Source
Transplant International. 25(7):748-57, 2012 Jul.
VI 1
Record Owner
Page 128
Status
MEDLINE
Authors
Israni AK; Snyder JJ; Skeans MA; Kasiske BL; PORT Investigators.
Authors Full Name
Israni, Ajay K; Snyder, Jon J; Skeans, Melissa A; Kasiske, Bertram L; PORT Investigators.
Institution
Israni, Ajay K. Chronic Disease Research Group, Minneapolis Medical Research Foundation,
Minneapolis, MN 55415, USA. isran001@umn.edu
Adolescent
Adult
Aged
*Coronary Disease/di [Diagnosis]
*Diabetes Mellitus/di [Diagnosis]
Female
Humans
Male
Middle Aged
Prevalence
Renal Insufficiency/co [Complications]
Risk
Risk Factors
Time Factors
Transplantation, Homologous
Abstract
Metabolic syndrome is associated with coronary heart disease (CHD) and new-onset diabetes after kidney
transplant (NODAT). Using data collected from transplant centers worldwide for the Patient Outcomes in
Renal Transplantation study, we examined associations of metabolic syndrome (n = 2253 excluding
recipients with diabetes pretransplant), CHD (n = 2253), and NODAT (n = 1840 further excluding
recipients with diabetes in the first year post-transplant), with the primary outcome of allograft failure. We
assessed risk factors associated with secondary outcomes of metabolic syndrome, NODAT, and CHD after
adjusting for type of baseline immunosuppression and transplant center effects. Metabolic syndrome
prevalence was 39.8% at 12-24 months post-transplant and 35.4% at 36-48 months. Metabolic syndrome
was independently associated with NODAT (hazard ratio 3.46, 95% confidence interval 2.40-4.98, P <
0.0001), CHD (2.03, 1.16-3.52, P = 0.013), and allograft failure (1.36, 1.03-1.79, P = 0.028). Allograft
failure occurred in 218 patients (14.6%). After adjustment for metabolic syndrome, NODAT (1.63, 1.18-
2.24, P = 0.003) and CHD (5.48, 3.27-9.20, P < 0.0001) remained strongly associated with increased risk of
allograft failure. Metabolic syndrome, NODAT, and CHD are risk factors for allograft failure. NODAT and
CHD are risk factors for allograft failure, independent of metabolic syndrome. Copyright © 2012 The
Authors. Transplant International © 2012 European Society for Organ Transplantation.
Publication Type
Year of Publication
2012

Page 129
<193>
Unique Identifier
22483466
Title
Serum adiponectin levels in renal transplant recipients with and without metabolic syndrome.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Shu KH; Tsai IC; Ho HC; Wu MJ; Chen CH; Cheng CH; Yu TM; Chuang YW; Huang ST.
Authors Full Name
Shu, K-H; Tsai, I-C; Ho, H-C; Wu, M-J; Chen, C-H; Cheng, C-H; Yu, T-M; Chuang, Y-W; Huang, S-T.
Institution
Hospital, Taichung, Taiwan. khshu@vghtc.gov.tw
Adult
Female
Humans
Male
*Metabolic Syndrome/bl [Blood]
Middle Aged
Abstract
OBJECTIVES: Adiponectin (APN) is an adipocyte-derived protein that has anti-inflammatory, anti-
atherogenic, and insulin-sensitizing effects. Lower serum APN level is associated with various
inflammatory and metabolic diseases in the general population. Kidney transplant (KT) recipients are at
higher risk for developing several metabolic disorders, including metabolic syndrome (MS). The aim of the
current study was to assess the change of APN level in KT recipients with and without MS.
METHODS: Prevalent KT recipients followed at our hospital were enrolled for the cross-sectional study
of MS. The modified Adult Treatment Panel III criteria adopted for the Asian population were used to
define MS. Overnight fasting blood samples were obtained for biochemistry and APN. APN was assayed
with a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The simplified
Modification of Diet in Renal Disease (MDRD) equation was used for the calculation of estimated
glomerular filtration rate (eGFR). Univariate and multivariate logistic regression were performed to
determine parameters that were associated with serum APN level.
RESULTS: A total of 271 KT recipients (male:female = 133:138), with a mean age of 52.3 +/- 12.6
years, were enrolled for the study of MS. The mean duration of follow-up posttransplantation was 9.02 +/-
5.91 years. MS was found in 72 of 271 KT recipients (26.6%). Patients with MS were older, had
significantly higher body weight, waist circumference, serum creatinine, fasting plasma sugar, and
hemoglobin A1c, but lower serum APN level and eGFR than did patients without MS. Univariate logistic
regression revealed the following variables were associated with APN level: MS, gender, body weight,
Page 130
body height, waist circumference, body mass index, serum creatinine, fasting blood sugar, triglyceride,
high-density lipoprotein (HDL) cholesterol, and eGFR. Multivariate analysis revealed that gender, body
weight, serum creatinine, triglyceride, and HDL cholesterol were associated with APN level.
CONCLUSION: Our results revealed that KT recipients with MS had significantly lower serum APN
levels, even in the presence of lower eGFR, than those without MS. Copyright © 2012 Elsevier Inc. All
rights reserved.
0 (Adiponectin).
Publication Type
Year of Publication
2012

<194>
Unique Identifier
22483460
Title
Fasting long-acting natriuretic peptide correlates inversely with metabolic syndrome in kidney transplant
patients.
Source
VI 1
Record Owner
Status
MEDLINE
Authors
Hsu BG; Shih MH; Yang YC; Ho GJ; Lee MC.
Authors Full Name
Hsu, B-G; Shih, M-H; Yang, Y-C; Ho, G-J; Lee, M-C.
Institution
Hsu, B-G. School of Medicine, Tzu Chi University, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Adult
Aged
*Fasting
Female
Humans
Immunoenzyme Techniques
Male
*Metabolic Syndrome/bl [Blood]
Middle Aged
*Natriuretic Peptides/bl [Blood]
Abstract
The metabolic syndrome (MetS) is a risk factor for posttransplant diabetes mellitus, chronic graft
dysfunction, graft loss, occurrence of atherosclerotic events, and patient death among kidney
transplantation patients. Long-acting natriuretic peptide (LANP) is among the peptide hormones in atrial
natriuretic peptide prohormone. Low levels of natriuretic peptide may lead to reduced lipolysis and
Page 131
excessive weight gain in obese patients. This study was undertaken to evaluate the relationship between
MetS and fasting serum LANP concentration among kidney transplanted patients. Fasting blood samples
were obtained from 69 kidney recipients. The MetS and its components were defined using the diagnostic
criteria of the International Diabetes Federation. Fasting LANP levels were measured using a commercial
enzyme immunoassay kit. The prevalence rate of MetS was 20.3% (14/69). Fasting LANP level negatively
correlated with MetS among these patients (P = .010). Using univariate linear regression analysis, serum
LANP values were negatively correlated with hemoglobin (r = -0.252; P = .037), and positively correlated
with blood urea nitrogen (r = 0.254; P = .035) and creatinine (r = 0.311; P = .009). Multivariate forward
stepwise linear regression analysis of the significant variables revealed that creatinine (R(2) change =
0.097; P = .009) was an independent predictor of fasting serum LANP concentration among kidney
transplanted patients. Serum LANP concentration correlates inversely with MetS; for these patients,
creatinine is an independent predictor of the serum LANP value. Copyright © 2012 Elsevier Inc. All rights
reserved.
0 (Natriuretic Peptides).
Publication Type
Year of Publication
2012

<195>
Unique Identifier
22445053
Title
Metabolic disorders following kidney transplantation. [Review]
Source
Journal of Renal Nutrition. 22(5):451-60.e1, 2012 Sep.
VI 1
Record Owner
Status
MEDLINE
Authors
Phillips S; Heuberger R.
Authors Full Name
Phillips, Stacey; Heuberger, Rochelle.
Institution
Phillips, Stacey. Foods and Nutrition, Central Michigan University, Mount Pleasant, USA.
staceycphillips@yahoo.com
Comorbidity
Diet
Exercise
Humans
Hyperlipidemias/ep [Epidemiology]
Hypertension/ep [Epidemiology]
Insulin Resistance
Kidney Failure, Chronic/dh [Diet Therapy]
Page 132
MEDLINE
Weight Gain
Abstract
Kidney transplantation in patients suffering from end-stage renal disease, although beneficial, may result
in potential complications increasing cardiovascular risk of mortality. Common metabolic problems after
surgery are weight gain, hypertension, hyperlipidemia, and insulin resistance. Immunosuppressant therapy
can enhance comorbidity progression. Early identification and treatment of these abnormalities can
promote transplant function. Lifestyle modifications have shown to be promising in the reduction of the
metabolic syndrome symptoms, but there remain limited trials focusing on this area. This article reflects a
comprehensive review of the available research of each of the potential metabolic complications within the
renal transplant population. Immunosuppressant medication effects, biochemical values, and medical
nutrition therapy intervention are also included with regard to their influence with these metabolic
disorders. Methods for review completion included a MEDLINE search for peer-reviewed research, using
the following keywords: transplant, chronic kidney disease, nutrition, metabolic syndrome, and diet after
transplantation. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights
reserved.
Publication Type
Year of Publication
2012

<196>
Unique Identifier
22441177
Title
Prevalence of metabolic syndrome and its associated factors in renal transplant recipients.
Source
Jornal Brasileiro de Nefrologia. 34(1):16-21, 2012 Mar.
VI 1
Record Owner
Status
MEDLINE
Authors
Teixeira AP; Fernandes NM; Mata GF; Chaoubah A; Paula RB; Bastos MG.
Authors Full Name
Teixeira, Ana Paula Simoes Ferreira; Fernandes, Natalia Maria da Silva; Mata, Gustavo Ferreira da;
Chaoubah, Alfredo; Paula, Rogerio Baumgratz de; Bastos, Marcus Gomes.
Institution
Teixeira, Ana Paula Simoes Ferreira. 1Nucleo Interdisciplinar de Estudos e Pesquisas em Nefrologia -
NIEPEN da Universidade Federal de Juiz de Fora - UFJF.
Page 133
Adult
Female
Humans
Male
Middle Aged
Prevalence
Risk Factors
Abstract
INTRODUCTION: The population of patients undergoing renal transplantation is considered at highrisk
for developing obesity and changes in lipid and glucose metabolism, due to the use of immunosuppressive
drugs and increased food freedom in the post-transplant period.
OBJECTIVE: This study was designed to assess the prevalence of metabolic syndrome in renal transplant
recipients and to identify factors associated with its occurrence.
METHODS: A cross-sectional study was performed in renal transplant patients, with more than six
months of follow-up. The metabolic syndrome was diagnosed according to the criteria of the National
Cholesterol Education Program Adult Treatment Panel III.
RESULTS: Among the 87 patients enrolled, 39 (44.8%) presented the phenotype of metabolic syndrome.
The mean age of the patients was 43.5 +/- 12.1 years-old, with a predominance of male (69.0%) and white
(66.7%). The mean and median times of post transplant follow-up were 64.2 +/- 49.4 and 56 months,
respectively. All the 12 patients who developed post-transplant diabetes mellitus also met the criteria for
metabolic syndrome, which compromised the inclusion of this variable in the logistic regression. In the
univariate analysis, patients with metabolic syndrome had higher mean age (p = 0.008), higher median
blood level of cyclosporine (p = 0.021), higher prevalence of history of coronary disease (p = 0.023), and
they were more frequent users of beta (p = 0.011) and calcium- channel blockers (p = 0.039). In the
multivariate analysis, age (HR = 1.06; 95% CI=1.01-1.11, p=0.006) and use of beta-blockers (HR = 4.02;
95% CI = 1.41 - 11.4, p = 0.009) were associated with increased risk of metabolic syndrome.
CONCLUSION: Metabolic syndrome was highly prevalent in the population of renal transplant
recipients studied, and it was associated with older age, use of beta-blockers, and post-transplant diabetes
mellitus.
Publication Type
Journal Article.
Year of Publication
2012

<197>
Unique Identifier
22364599
Title
Cellular and physiological mechanisms of new-onset diabetes mellitus after solid organ transplantation.
[Review]
Source
Diabetic Medicine. 29(7):e1-12, 2012 Jul.
Page 134
VI 1
Record Owner
Status
MEDLINE
Authors
Dong M; Parsaik AK; Eberhardt NL; Basu A; Cosio FG; Kudva YC.
Authors Full Name
Dong, M; Parsaik, A K; Eberhardt, N L; Basu, A; Cosio, F G; Kudva, Y C.
Institution
Dong, M. Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
55902, USA.
Diabetes Mellitus, Type 2/im [Immunology]
Diabetes Mellitus, Type 2/mo [Mortality]
*Diabetes Mellitus, Type 2/pp [Physiopathology]
Heart Transplantation/ae [Adverse Effects]
Humans
*Hypoglycemic Agents/tu [Therapeutic Use]
*Immunosuppression/ae [Adverse Effects]
*Insulin/tu [Therapeutic Use]
Insulin Resistance
Liver Transplantation/ae [Adverse Effects]
*Organ Transplantation/ae [Adverse Effects]
Organ Transplantation/mo [Mortality]
Risk Factors
Abstract
New-onset diabetes after transplantation is recognized as one of the metabolic consequences which may
increase the risk of morbidity and mortality after solid organ transplantation. The pathophysiology of new-
onset diabetes after transplantation has not been clearly defined and may resemble that of Type 2 diabetes,
characterized by predominantly insulin resistance or defective insulin secretion, or both. This review aims
to summarize the current state of knowledge regarding the prevalence, consequences, pathogenesis, and
management of new-onset diabetes after transplantation, with a major focus on the possible mechanisms
involved in the pathogenesis of the disorder. The aetiology of new-onset diabetes after transplantation is
multifactorial, with diabetogenic immunosuppressive drugs playing a major role. Multiple cellular and
physiologic mechanisms are involved in the process. Selection of an appropriate maintenance
immunosuppressive regimen should involve balancing the risk of patient and graft survival vs. the potential
for new-onset diabetes after transplantation. Copyright © 2012 The Authors. Diabetic Medicine © 2012
Diabetes UK.
0 (Blood Glucose). 0 (Hypoglycemic Agents). 0 (Immunosuppressive Agents). 0 (Insulin).
Publication Type
Year of Publication
2012

Page 135
<198>
Unique Identifier
22200435
Title
New-onset posttransplant diabetes mellitus begins in the dialysis period. [Review]
Source
Journal of Renal Nutrition. 22(1):162-5, 2012 Jan.
VI 1
Record Owner
Status
MEDLINE
Authors
Madziarska K; Klinger M.
Authors Full Name
Madziarska, Katarzyna; Klinger, Marian.
Institution
Madziarska, Katarzyna. Department of Nephrology and Transplantation Medicine, Wroclaw Medical
University, Wroclaw, Poland.
Age Factors
Diabetes Mellitus/ge [Genetics]
Glucose Intolerance
Hepatitis C/co [Complications]
Humans
Kidney Transplantation/mo [Mortality]
Peritoneal Dialysis/ae [Adverse Effects]
*Renal Dialysis
Risk Factors
Abstract
OBJECTIVES: New-onset posttransplant diabetes mellitus (PTDM) affects >20% of transplant recipients
at 1 year and is associated with increased risk of mortality. From the pathogenetic point of view, PTDM
can be considered as the consequence of predisposing factors existing in the dialysis period, which are
triggered by immunosuppressive drugs, calcineurin inhibitors, mTOR inhibitors, and steroids.
DESIGN, PATIENTS, AND MAIN OUTCOME MEASURE: In our own study, the independent
predictors of PTDM were recipient age, a positive family history of diabetes, and treatment by peritoneal
dialysis. Other clinical investigations have added the presence of metabolic syndrome components and
hepatitis C infection to this list.
CONCLUSIONS: Estimation of the risk of development of PTDM should be an integral element in the
qualification process for the waiting list. An intensive lifestyle modification program should be offered to
candidates with impaired glucose tolerance. Copyright © 2012 National Kidney Foundation, Inc. Published
by Elsevier Inc. All rights reserved.
Publication Type
Year of Publication
2012
Page 136
<199>
Unique Identifier
22054874
Title
Leptin, insulin resistance, and metabolic changes 5 years after renal transplantation.
Source
Journal of Renal Nutrition. 22(4):440-9, 2012 Jul.
VI 1
Record Owner
Status
MEDLINE
Authors
Nicoletto BB; Souza GC; Goncalves LF; Costa C; Perry IS; Manfro RC.
Authors Full Name
Nicoletto, Bruna Bellincanta; Souza, Gabriela Correa; Goncalves, Luiz Felipe; Costa, Cesar; Perry, Ingrid
S; Manfro, Roberto Ceratti.
Institution
Nicoletto, Bruna Bellincanta. Nutrition Course, School of Medicine, Federal University of Rio Grande do
Sul-UFRGS, Porto Alegre, Rio Grande do Sul, Brazil.
Adult
Body Composition
Body Mass Index
Cardiovascular Diseases/ep [Epidemiology]
Cholesterol, LDL/bl [Blood]
Female
Follow-Up Studies
Humans
Incidence
*Insulin Resistance
*Leptin/bl [Blood]
Linear Models
Male
*Metabolome
Middle Aged
Triglycerides/bl [Blood]
Abstract
OBJECTIVE: To evaluate leptin, insulin resistance (IR), and changes in body composition and lipid
profile within 5 years after renal transplantation.
DESIGN: Longitudinal study.
SETTING: Hospital de Clinicas de Porto Alegre/RS, Brazil.
SUBJECTS: Thirty-two renal transplant recipients were followed up for 5 years after transplantation.
Page 137
METHODS: Data were collected at transplantation time (T1) and after 3 months (T2), 1 year (T3), and 5
years (T4). Leptin serum levels, IR assessed by homeostasis model assessment (HOMA) index, lipid
profile, and anthropometric measurements were analyzed. Data were compared with a control group at
baseline.
RESULTS: At T1, pretransplant patients had leptin levels (ng/mL) (11.9 [9.2 to 25.2]) higher than the
control group (7.7 [5.2 to 9.9]; P < .0001). After transplantation, levels decreased at T2 and T3, but
increased at T4 to values similar to those seen at T1 (T4: 9.2 [5.7 to 21]; P = 1). HOMA also decreased at
T2, but increased at T4 to identical levels (T1: 2.1 [1.63 to 2.23], T4: 2.1 [1.6 to 2.85]; P = 1). No
significant changes in body fat percentage (BF%) were observed; however, the arm muscle circumference
increased significantly at T4 (P < .0001). At T2, total cholesterol, triglycerides, and low-density lipoprotein
cholesterol increased, whereas at T4, lipid profile moved toward T1 levels. By linear regression analysis,
gender, BF%, and HOMA were independent predictors of leptin levels. A trend toward higher body mass
index was observed in woman who also presented higher leptin and lower HOMA levels.
CONCLUSION: Leptin levels and HOMA decrease in the immediate posttransplant period and remain
reduced for at least 1 year. Five years post transplantation, leptin, IR, BF%, and lipids have a profile similar
to those in the pretransplant period. This metabolic profile is possibly associated with the elevated
incidence of cardiovascular diseases observed in the late posttransplant period. Copyright © 2012 National
Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
0 (Biomarkers). 0 (Cholesterol, LDL). 0 (Leptin). 0 (Triglycerides).
Publication Type
Year of Publication
2012

<200>
Unique Identifier
21725919
Title
Graft loss risk in renal transplant recipients with metabolic syndrome: subgroup analyses of the ALERT
trial.
Source
Journal of Nephrology. 25(2):245-54, 2012 Mar-Apr.
VI 1
Record Owner
Status
MEDLINE
Authors
Soveri I; Abedini S; Holdaas H; Jardine A; Eriksson N; Fellstrom B.
Authors Full Name
Soveri, Inga; Abedini, Sadollah; Holdaas, Hallvard; Jardine, Alan; Eriksson, Niclas; Fellstrom, Bengt.
Institution
Soveri, Inga. Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
inga.soveri@medsci.uu.se
Adult
Aged
Page 138
Creatinine/bl [Blood]
Double-Blind Method
*Fatty Acids, Monounsaturated/tu [Therapeutic Use]
Female
Fluvastatin
Follow-Up Studies
*Graft Survival
Humans
*Hydroxymethylglutaryl-CoA Reductase Inhibitors/tu [Therapeutic Use]
Immune Tolerance
*Indoles/tu [Therapeutic Use]
Male
Middle Aged
Risk Factors
Abstract
BACKGROUND: Several nonimmunologic risk factors for late renal graft loss (RGL) are also known
components of metabolic syndrome (MS). We aimed to study MS as a risk factor for RGL. Also, the effect
of statin treatment in reducing renal risk in renal transplant recipients (RTRs) with MS was studied.
METHODS: Nondiabetic RTRs (n=1,706) from the ALERT trial were followed for 7-8 years. MS was
defined according to National Cholesterol Education Program Adult Treatment Panel III definition with
waist girth replaced by BMI >=30 (calculated as kg/m(2)). Renal end points included death-censored RGL
and graft loss or doubling of serum creatinine.
RESULTS: During the follow-up, 284 patients experienced RGL, and there were 343 cases of graft loss
or doubling of serum creatinine. Those with MS had increased risk for RGL (relative risk = 1.28, 95%
confidence interval, 1.00-1.63; p=0.047), but not for the combined end point. After adjustment for other
known and potential risk factors, MS was no longer associated with increased risk for RGL. The
association between MS and RGL risk was attenuated once adjustment for creatinine was made. Statin
treatment did not reduce the risk for renal end points in RTRs with or without MS.
CONCLUSION: MS had no independent association with RGL risk. Adjustment for renal function
attenuated the association between MS and RGL.
0 (Fatty Acids, Monounsaturated). 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors). 0 (Indoles).
4L066368AS (Fluvastatin). AYI8EX34EU (Creatinine).
Publication Type
Journal Article. Randomized Controlled Trial. Research Support, Non-U.S. Gov't.
Year of Publication
2012

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CONCLUSION: In 31 % a disorder of glucose metabolism was found as a frequent complication after

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METHODS/DESIGN: We designed this prospective, single-centre, open-label, randomised controlled

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METHODS: A prospective, monocentric cohort of consecutive type 2 diabetes patients (the

CONCLUSIONS/INTERPRETATION: In patients with type 2 diabetes, serum ANGPTL2

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CONCLUSION: Pretransplant hypomagnesemia is an independent risk factor of NODAT. Therefore, it is

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CONCLUSIONS: The prevalence of DM or prediabetes on kidney transplant waiting list is as high as

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DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: The longitudinal relationship

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METHODS: To determine if there is adiponectin resistance in ESRD, we measured tissue levels of

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CONCLUSIONS: Compared to tacrolimus treatment, cyclosporine treatment was associated with a

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