Abdominal waist circumference and subcutaneous adipose tissue thickness predicts development of post-transplant diabetes mellitus.

BACKGROUND

Post-transplant diabetes mellitus (PTDM) is a major comorbidity affecting 10-40% of kidney transplant recipients with significant clinical consequences including diabetic microvascular and macrovascular complications, infectious complications, allograft loss, and mortality. Although multiple modifiable and non-modifiable risk factors have been identified for PTDM development, there is a strong need for higher quality determinants of PTDM risk for early identification of high-risk patients. We hereby aim to evaluate the efficacy of abdominal waist circumference and subcutaneous adipose tissue thickness as predictors of PTDM among kidney transplant recipients.

METHODS

We have performed a single-center retrospective clinical study involving non-diabetic kidney transplant recipients between December 2018 and January 2025. Baseline demographic and clinical data, laboratory workup and pre-transplant abdominal computed tomography (CT) were utilized. Abdominal waist circumference and subcutaneous adipose tissue thickness were obtained from the abdominal CT scan. The diagnosis of PTDM was based upon the criteria established by the American Diabetes Association.

RESULTS

We have included a total of 478 adult kidney transplant recipients with a mean age of 41.1 with slight female predominance (57.1%). Patients developing PTDM were more likely to be elderly, have higher body-mass index, higher abdominal subcutaneous adipose tissue thickness, higher abdominal waist circumference and higher baseline serum glucose and triglyceride levels compared to patients not developing PTDM (p value < 0.001 for all). The pairwise comparison of the ROC curve data for such variables has revealed the superiority of higher abdominal subcutaneous adipose tissue thickness and abdominal waist circumference in predicting PTDM risk over body-mass index among kidney transplant recipients.

CONCLUSIONS

We have identified two independent risk factors for PTDM development as abdominal waist circumference and abdominal subcutaneous adipose tissue thickness.

KEY LEARNING POINTS: What was known: Post-transplant diabetes mellitus is a major comorbidity affecting 10-40% of kidney transplant recipients with significant clinical consequences including diabetic microvascular and macrovascular complications, infectious complications, allograft loss, and mortality. This study adds: Abdominal waist circumference and subcutaneous adipose tissue thickness, measured by abdominal CT scan, predict the development of post-transplant diabetes mellitus better than body-mass index. Potential impact: Baseline measurement of abdominal waist circumference and subcutaneous adipose tissue thickness may help to predict the development of post-transplant diabetes mellitus. This may also facilitate early management of these patients.