Les troubles métaboliques chez les transplantés rénaux : incidence et impacts

Abstract

Metabolic complications after kidney transplantation (diabetes, dyslipidemia, hyperuricemia, obesity), mainly due to immunosuppressive therapy, become a preoccupation because it represents a morbimortality risk factor and allograft loss. The goal of our study is to evaluate the frequency and the profile of those anomalies after kidney transplantation. It’s a prospective, descriptive study, in which we included all transplant patients in our centre since March 2014; we have identified recipient specific demographic data, immunosuppressive agents after kidney transplantation. The clinical and biological parameters collected are (Body Mass Index (BMI), fasting blood sugar, Hemoglobin A1c, cholesterol, C-HDL, C-LDL, TG, uric acid). One hundred and three patients were collected, medium age was at 36± 5 yo, with extremes (12 to 65 Years old) and a sex ration at 2.55 with a masculine predomination. Seventy three (70.9%) had high blood pressure before kidney transplantation and 2.9% were diabetic. Medium age of the donors is at 43.5 ± 4.7 YO (25-64). The immunosuppressive therapy during the induction phase was either using ATG for 78.6% of patients or using BASILIXIMAB for 21.4 % of patients. For the maintenance phase: all patients were on corticosteroids, 58.3% were on Tacrolimus whereas the rest were on Ciclosporins. The MMF was prescribed for 96.1% of cases, and Azathioprin for 3.9 % of cases. Medium BMI was at 27.9 +/- 2.4 (17.5-41), 41% of patients were considered to be on overweight of which 33.5% were obese. Hypercholesterolemia was found among 41.31% of cases whereas hyperuricemia was found among 27% of cases. Twenty four transplant patients developed diabetes after 24 months of follow up which represents 23.76% of cases. Allograft loss for one patient and another patient died with a functional allograft. The metabolic complications after kidney transplantation are frequent and deserve a particular attention because they are one of the major morbidity and mortality factors.