Clinical Predictors and Outcomes of Post-transplantation Diabetes Mellitus in an Indian Kidney Transplant Cohort: The Predictive Value of Early Postoperative Hyperglycaemia.

BACKGROUND

Post-transplantation diabetes mellitus (PTDM), formerly termed new-onset diabetes after transplantation, is a major metabolic complication of kidney transplantation that increases cardiovascular risk and jeopardises patient and graft survival. Although well characterised in Western populations, Indian data remain limited, particularly regarding the significance of hyperglycaemia recognised during the index transplant hospitalisation.

METHODS

A single-centre retrospective cohort study was conducted of 40 consecutive adult recipients of a first kidney transplant without pre-existing diabetes (May 2023 to December 2024) at a tertiary centre in central India. All patients received tacrolimus-, corticosteroid-, and mycophenolate-based immunosuppression. Inpatient capillary glucose trends, lipid profile, viral serology, and tacrolimus trough concentrations were recorded. PTDM was defined using the American Diabetes Association criteria, applied once patients were clinically stable. Continuous variables were compared using Student's t-test and categorical variables using Fisher's exact test; given the small number of events, analyses were restricted to univariable comparisons.

RESULTS

The cumulative incidence of PTDM was 20% (8/40). Affected recipients were older (42.8 ± 7.5 vs. 28.1 ± 10.1 years; p < 0.001), with higher body mass index (20.3 ± 1.7 vs. 17.4 ± 1.9 kg/m²; p < 0.001) and higher pre-transplant triglycerides (122 ± 26 vs. 98 ± 27 mg/dL; p = 0.03). Postoperative hyperglycaemia occurred in 25.0% of the cohort (10/40) and was strongly associated with PTDM, present in six of eight PTDM recipients (75.0%) versus four of 32 without PTDM (12.5%; p = 0.001). All cases were diagnosed within four months of transplantation, frequently in the setting of tacrolimus troughs >15 ng/mL. Three patients (3/8, 37.5%) had transient and five (5/8, 62.5%) had persistent disease. Graft function and rejection rates were comparable between groups.

CONCLUSIONS

PTDM developed in one-fifth of this Indian cohort. Hyperglycaemia detected during the index hospitalisation, together with older age and an adverse pre-transplant metabolic profile, identified recipients at higher risk. Systematic inpatient glucose surveillance offers an actionable window for early intervention, consistent with randomised evidence that early basal-insulin therapy can attenuate progression to sustained PTDM.