©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Impact of immunosuppression on incidence of post-transplant diabetes mellitus in solid organ transplant recipients: Systematic review and meta-analysis
Sreelakshmi Kotha, Bishoy Lawendy, Saira Asim, Charlene Gomes, Jeffrey Yu, Ani Orchanian-Cheff, George Tomlinson, Mamatha Bhat
Sreelakshmi Kotha, Department of Gastroenterology, Guy's and St Thomas' Hospital, London SE1 7JD, United Kingdom
Bishoy Lawendy, Charlene Gomes, Jeffrey Yu, Ani Orchanian-Cheff, Department of Multi-Organ Transplantation, Toronto General Hospital, Toronto M5G 2C4, Canada
Saira Asim, Multi Organ Transplant Program, Toronto General Hospital, Toronto M5G 2C4, Canada
George Tomlinson, Dalla Lana School of Public Health, Department of Medicine, University Health Network - Toronto General Hospital, University of Toronto, Toronto M5G 2C4, Canada
Mamatha Bhat, Multi-organ Transplant, Toronto General Hospital, Toronto M5G 2C4, Canada
Author contributions: Kotha S and Bhat M designed the study; Kotha S, Lawendy B, Asim S, Gomes C, Yu J and Bhat M collected the data; Kotha S, Lawendy B, Tomlinson G and Bhat M wrote the paper; Orchanian-Cheff A did the literature search; Tomlinson G made the data analysis; and All authors finally approved this manuscript.
Conflict-of-interest statement: There is no conflict of interest for any of the authors
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sreelakshmi Kotha, MBBS, MRCP, Staff Physician, Department of Gastroenterology, Guy's and St Thomas' Hospital, Westminster B ridge Road, London SE1 7JD, United Kingdom. firstname.lastname@example.org
Received: June 20, 2021
Peer-review started: June 20, 2021
First decision: July 28, 2021
Revised: August 27, 2021
Accepted: September 19, 2021
Article in press: September 19, 2021
Published online: October 18, 2021
Solid organ transplantation is a life-saving intervention for end-stage organ disease. Post-transplant diabetes mellitus (PTDM) is a common complication in solid organ transplant recipients, and significantly compromises long-term survival beyond a year.
To perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM.
Two hundred and six eligible studies identified 75595 patients on Tacrolimus, 51242 on Cyclosporine and 3020 on Sirolimus. Random effects meta-analyses was used to calculate incidence.
Network meta-analysis estimated the overall risk of developing PTDM was higher with tacrolimus (OR = 1.4 95%CI: 1.0–2.0) and sirolimus (OR = 1.8; 95%CI: 1.5–2.2) than with Cyclosporine. The overall incidence of PTDM at years 2-3 was 17% for kidney, 19% for liver and 22% for heart. The risk factors for PTDM most frequently identified in the primary studies were age, body mass index, hepatitis C, and African American descent.
Tacrolimus tends to exhibit higher diabetogenicity in the short-term (2-3 years post-transplant), whereas sirolimus exhibits higher diabetogenicity in the long-term (5-10 years post-transplant). This study will aid clinicians in recognition of risk factors for PTDM and encourage careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.
Core Tip: The aim of this study is to perform a systematic review and meta-analysis to estimate incidence of post-transplant diabetes mellitus (PTDM) and the relative effects of the 3 major immunosuppressants on incidence of PTDM. This study will aid clinicians in recognizing the risk factors for PTDM and careful evaluation of the risk/benefit of different immunosuppressant regimens in transplant recipients.