Risk Factors For New-onset Diabetes Mellitus After Kidney Transplantation:a Systematic Review And Meta-analysis

Objective:To systematically review the risk factors for new-onset diabetes mellitus after kidney transplantation,and to provide a theoretical basis for the prevention and management of new-onset diabetes mellitus after kidney transplantation.Methods:We searched Pub Med,Web of Science,Embase,the Cochrane Library databases and other databases for case–control studies related to risk factors for new–onset diabetes mellitus after kidney transplantation published between January 2005 and July 2019.A metaanalysis of data on risk factors for new-onset diabetes mellitus after kidney transplantation from the included studies was carried out.A systematic review of risk factors for new-onset diabetes mellitus after kidney transplantation was also carried out.Results:A total of 24 case–control studies were included in the meta-analysis,with a total of 7,140 patients.There were 1,598 patients with new-onset diabetes mellitus after kidney transplantation,and 5,542 patients without new-onset diabetes mellitus after kidney transplantation.The meta-analysis results showed that age [mean difference(MD)= 6.05,95% confidence interval(CI)(4.33,7.78),P < 0.00001],polycystic kidney disease [odds ratio(OR)= 1.69,95% CI(1.22,2.34),P = 0.002],family history of diabetes [OR=3.14,95%CI(1.87,5.27),P< 0.0001],body mass index [MD=1.82,95%CI(1.35,2.30),P <0.00001],acute rejection [OR=1.97,95%CI(1.61,2.41),P < 0.00001],tacrolimus use [OR=1.20,95%CI(1.02,1.41),P=0.03],hepatitis B virus infection [OR=3.53,95%CI(1.12,11.13),P =0.03],hepatitis C virus infection [OR=1.51,95%CI(1.01,2.24),P =0.04] and hypertension [OR=1.48,95%CI(1.19,1.85),P =0.0004] were associated with new-onset diabetes mellitus after kidney transplantation,whereas sex [OR=1.00,95%CI(0.88,1.13),P=0.97],sirolimus use [OR=2.21,95%CI(0.96,5.09),P=0.06],cyclosporin A use [OR=0.91,95%CI(0.63,1.31),P=0.61],steroid use [OR = 1.42,95% CI(0.97,2.08),P = 0.07] and cytomegalovirus infection [OR=1.11,95%CI(0.81,1.53),P =0.51] were not associated with new-onset diabetes mellitus after kidney transplantation..Conclusion:Older age,higher body mass index,family history of diabetes,tacrolimus use,history of hypertension,polycystic kidney disease,acute rejection,hepatitis B virus infection and hepatitis C virus infection are risk factors for new-onset diabetes mellitus after kidney transplantation.Therefore,the clinical implications of these factors warrant attention.