Post-Transplant Diabetes Mellitus in Renal Transplant Recipients, Single-Centre Data: Incidence, Risk Factors, and Effect on Graft Function and Mortality

Background: De novo post-transplant diabetes mellitus (PTDM) is a frequent complication among renal transplant recipients; it confers a high risk for graft failure and patient mortality. This single-centre study aimed to determine the incidence and risk factors of PTDM and its effects on graft outcome and mortality. Methods: In a single-centre longitudinal cohort analysis of 383 non-diabetic renal transplant follow-up recipients, outcomes were analysed through a detailed chart review. We hypothesized that different donor and recipient characters such as age, gender, and HLA mismatch would affect PTDM development in renal transplant recipients. PTDM is defined on basis of fasting plasma sugar (≥7 mmol/L or ≥126 mg/dL), random plasma sugar (≥11.1 mmol/L or ≥200 mg/dL), and glycated haemoglobin (HBA1C: >6.5% or 48 mmol/mol). We assessed PTDM incidence, risk factors, and its effect on patient mortality and graft outcome using Cox regression. Results: The mean age at the time of transplantation was 35.70 (±14.27) years, and 50.91% were male. PTDM incidence in the study period was 23.30%. Independent risk factors include older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus infection. PTDM is not associated with graft dysfunction, whereas it significantly carries high mortality. Conclusion: PTDM is common among renal transplant recipients. Older age at the time of transplantation, cyclosporine immunosuppression, cytomegalovirus, and hepatitis C virus are risk factors. PTDM carries high mortality but is not associated with graft failure

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Epidemiology of end-stage renal disease in Dubai: Single-center data

Hemodialysis (HD) was first established in Dubai in the year 1980 and was in its full capacity by the year 1983. Since then, the HD population has been growing rapidly. This report represents the demographic data and clinical characteristics of our HD patients during the period between January 2012 and October 2016. Diabetic nephropathy (57%) and hypertension (12.4%) are emerging as the most common causes of end-stage renal disease (ESRD) in our data, followed by undetermined causes in those who presented as ESRD (10.9%), and then by rejected transplant in 4.6%. Obstructive uropathy in our data was 4.37% among all causes. The causes were primary glomerulonephritis (only proven cases in kidney biopsy were counted) in 3.6%, adult polycystic kidney disease in 2.43%, and lupus nephritis in 1.45% of cases. The prevalence of ESRD in the current study was 152 patients per million population per year

Renal allograft survival: Incidence and risk factors associated with graft dysfunction

Background: Renal transplantation is considered the best available therapy for patients suffering from end-stage kidney disease. Improvement in allograft outcome, patient survival, and quality of life are the most important indicators of the effectiveness of renal transplantation. Short-term allograft survival has improved significantly, however, long-term allograft survival and associated risk factors need to be studied. Objectives: This single-center study aims to determine the incidence of long-term graft dysfunction (GD) and the associated risk factors among renal transplant recipients in Dubai Hospital, Dubai, United Arab Emirates. Materials and Methods: A single-center longitudinal cohort analysis of 506 renal transplant follow-up recipients' allograft functions was analyzed through a detailed chart review. We hypothesized that different recipients' characteristics such as age (present and age at the time of transplantation), gender, history of acute rejection, posttransplant viral infections (hepatitis B virus, hepatitis C virus [HCV], Cytomegalovirus, BK virus), and comorbid would affect allograft function in renal transplant recipients. Allograft dysfunction is defined as a 15%–20% increase in creatinine from baseline. We assessed the incidence of allograft dysfunction and associated risk factors. Results: The median age of transplant recipients and the age at the time of transplantation were 55 ± 21 and 39 ± 14.93 years, respectively. About 61.85% (n = 313) of the transplant population were males. The incidence of allograft dysfunction in the study period was 57.15%. In our study population, 1-, 5-, and 10-year graft survival rate was 98.62%, 82.35%, and 54.90%, respectively. Independent risk factors include age, male gender, history of acute rejection, HCV infection, and diabetes mellitus (DM). Posttransplant DM (PTDM) is not associated with GD. Conclusion: Allograft dysfunction is quite common among renal transplant recipients. Independent risk factors in our analysis include age, male gender, history of acute rejection, HCV infection, and DM. PTDM is not associated with GD