Pre-Transplant Inflammation Can Lead to Post-Transplant Diabetes

Findings published in CardioRenal Medicine suggest a potential link between inflammation in patients prior to receiving an organ transplant and the increased likelihood of developing diabetes.

It’s estimated that up to 30% of transplant recipients will develop diabetes. Although the reasons are unclear, physicians have often placed blame on immunosuppressive drugs that transplant patients receive.

“For patients who have received a new lease on life from a donated kidney, developing diabetes can be a major blow,” said first study author Maria Martinez Cantarin, MD. “We hadn't had a good sense of how diabetes could be avoided for these patients.”

In order to gain a better understanding of the process that leads to the development of diabetes in transplant recipients, researchers collected tissue and blood samples from 32 kidney recipients and 36 kidney donors. Within 1 year of follow-up, 11 out of 36 kidney recipients developed diabetes.

Researchers compared levels of tumor necrosis factor alpha (TNF-alpha) and found that patients who developed diabetes had higher levels of TNF-alpha in their blood before undergoing surgery, compared with transplant recipients who didn’t develop the disease. For every 25% increase in TNF-alpha, the patients doubled their risk of developing diabetes.

When researchers went to examine the patient’s fat tissue, they hypothesized that the fat was beneficial to the recipients.

“Patients on dialysis, who eventually end up needing new kidneys, typically lose weight,” Cantarin said. “So we tend to think of a little extra fat as a good thing. Heavier patients do better.”

However, when fat tissue was sampled from the donor and kidney transplant recipients, they found that participants who developed diabetes had a 40% higher production of TNF-alpha than participants who did not.

The findings suggest that because certain patients have fat that produces high levels of TNF-alpha, the fat increases their chances of developing diabetes instead of acting as protection, the study concluded.

“The finding is important because it changes our focus as clinicians,” Cantarin said. “Before, diabetes seemed like an inevitable side effect of the transplantation process. This study points to the idea that we may be able help the patient alter or control inflammation prior to transplantation in order to reduce the risk of developing diabetes.”