Hyperglycemia and (Pre)Diabetes in Pediatric Renal and Liver Transplantation.
Condition: Diabetes Mellitus Risk
MeSH terms: Diabetes Mellitus
Study type: Interventional

Summary: 
      Background: Diabetes is a common complication of transplantation and is associated with
      unfavorable medical outcome and increased cardiovascular disease at long term. However,
      prediabetes defined by an impaired glucose tolerance and/or impaired fasting glucose is
      rarely sought in pediatric liver (LT) and renal (RT) transplantation, while its presence
      indicates a high risk of overt diabetes and complications thereof. Early detection of
      hyperglycemia might mitigate those risks. The objectives of the DIABGRAFT study were to
      retrospectively (rDIABGRAFT) and longitudinally (pDIABGRAFT) characterize hyperglycemia and
      (pre)diabetes in a cohort of children with RT or/and LT.

      Methods: The investigators retrospectively collected data about 195 children with LT from
      2012 and 2019 and twenty children with RT from 2005 to 2019 in Cliniques universitaires Saint
      Luc to determine the incidence, risk factors and time at onset of chronic hyperglycemia. In
      addition, the investigators prospectively followed four LT and four RT children between 2019
      and 2022 to evaluate the evolution of their glucose metabolism.
    

Detailed description: 
      BACKGROUND/AIM: Solid organ transplantation (SOT) is therapeutic choice for patient in
      end-stage renal or liver disease. After transplant, immunosuppressive therapy is necessary to
      avoid rejection and their use has enabled SOT and considerably improved graft survival and
      quality of life. However, they are also associated with side effects, including glycemic
      abnormalities. Most complications observed with immunosuppressants are the presence of
      hyperglycemia which in the long term may increase the probabilities to develop persistent
      diabetes. Diabetes affects an ill-defined proportion of transplanted patients (2 to 53%) and
      in the context of adult liver and renal transplant, it is nonetheless common, and represents
      approximately 20%. However, the incidence of transient hyperglycemia and the probabilities to
      develop overt diabetes in pediatric liver and renal transplantation remains unknow, while it
      is known that both is associated with an unfavorable prognosis (i.e., mortality, graft
      rejection, increased hospital stay) and an increased cardiovascular event in the long term.
      Moreover, associated risk factors such as obesity, metabolic syndrome, sedentary lifestyle,
      or even older age are well known for adult transplant but do not make sense for children
      transplanted at a very young age. In addition, the use of a non-relevant measure such as
      fasting blood glucose and a late-onset diabetes marker like HbA1C levels do not allow the
      early detection of impaired glucose tolerance (IGT) a signal alarm of a prediabetes state.
      Prediabetes is considered as an intermediate state between normal glucose homeostasis and
      overt diabetes and represents a major health problem because it is estimated in 2015 that 70%
      of the prediabetic American citizens (33,5%) will develop diabetes in the period. However, it
      is rarely sought in pediatric transplantation while the early detection and correction of
      hyperglycemia was shown to significantly decrease both cardiovascular and diabetes risk. It
      is therefore essential to develop knowledge on the evolution of glucose dysregulation after a
      renal and liver transplantation with the implementation of other markers of hyperglycemia or
      IGT. Then the purpose of the DIABGRAFT study was to assess the incidence and associated risk
      factors of developing hyperglycemia in renal and liver transplanted children to anticipate it
      and analyze their glycemic profile during the most critical moment to characterize
      hyperglycemia, IGT and diabetes.

      METHODS: In collaboration with the Pediatric Gastroenterology and Specialized Pediatrics
      Services (Endocrinology and Nephrology Units) of Cliniques universitaires Saint Luc (CUSL) in
      Belgium (Brussels), this clinical study will be organized as a retrospective and a
      prospective trial.

      The study included liver and renal transplanted pediatric patients (<18 years of age) at
      CUSL. Were excluded patients with a history of diabetes (i.e., type 1, type 2, neonatal or
      monogenic), pancreatitis, Down Syndrome, cystic fibrosis, another transplantation (cardiac,
      renal) only for liver transplanted patients, patients deceased shortly after transplantation,
      and patients with incomplete medical record.

      Its retrospective part (rDIABGRAFT) consisted of collecting data of pediatric patients who
      benefited from a liver transplant performed at CUSL between April 2012 and April 2019, or
      that benefited from a renal transplant in our center between April 2005 and April 2019.

      The prospective part (pDIABGRAFT) of the study consisted of a longitudinal glycemic
      evaluation of renal and liver transplanted children in CUSL between 2020 and 2022 with the
      use of dynamic endocrine testing. Informed consents were collected from parents and from all
      children over six years of age.
    

Intervention name(s): evaluation of second line glucose homeostasis
Intervention type(s): Diagnostic Test
Intervention description(s): blood samples, urine samples, genetic test, peptide C stimulation test, OGTT, continuous glucose monitoring and questionnaires
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Screening