Determination Of Risk Factors And Establishment Of Risk Prediction Models For New Onset Diabetes After Heart Transplantation

Purpose: The aim of the present study was to investigate the risk factors for new-onset diabetes after transplantation(NODAT)in Chinese heart transplant recipients and to develop predictive models for prediction of NODAT.Methods: Adult patients without diabetes before heart transplantation were enrolled.Clinical data were collected and 18 SNPs in 16 genes were assessed for the association with NODAT.NODAT was defined according to the criteria of American Diabetes Association.Risk factors of for NODAT were identified by logistic regression analysis.The predictive models of NODAT were developed by adding identified risk factors.The final model was internally validated using the Bootstrap method.Results: Among the enrolled 204 heart recipients,64(31.4%)were identified as NODAT.CCL5(chemokine ligand 5,CCL5)rs2280789 was significantly associated with NODAT.CCL5 rs2280789 G allele carriers were at 2.76-fold higher risk for(OR 2.76,95% CI 1.23-6.18;p = 0.014)NODAT than the wild type.Clinical independent risk factors of NODAT were age(OR 2.53 for ? 45 years,95% CI 1.14-5.62;p = 0.023),transient hyperglycemia(OR 12.29,95% CI 3.94-38.31;p = 1.54×10-5)and dose-adjusted target trough concentration(C0/D)of tacrolimus(OR 6.75 for ? 165 ng·m L-1per mg·kg-1·d-1,95% CI 3.07-14.85;p = 2.11×10-6).The final predictive model included 4 variables and obtained an area under the receiver-operating characteristic(ROC)curve(AUROC)of 0.838(95% CI 0.779-0.897).Conclusion: Age(? 45 years),transient hyperglycemia,tacrolimus C0/D(? 165 ng·m L-1per mg·kg-1·d-1)and CCL5 rs2280789 G allele were independent risk factors of NODAT.The model built with these risk factors showed a good ability in predicting the risk of NODAT.Moreover,the model could easily identify the high-risk recipients of NODAT after heart transplantation,which would allow more timely preventive interventions to be made.