Abstract Ref Number = APCP834
Post-transplant Diabetes Mellitus in Pediatric Kidney Transplantation 1st Case Report in Indonesia One-year Follow-up Result
Jennie Sutantio,Bambang Tridjaja,Eka Laksmi
RSCM Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
Background : Post-transplant diabetes mellitus (PTDM) results in serious cardiovascular effects and increased mortality rate in adults. Long-term prognosis in children is still under debate. We aim to report one-year follow up result of PTDM in a pediatric kidney transplant patient in Indonesia.
Case Presentation Summary : A 15-year-old girl with end-stage renal disease secondary to steroid-resistant nephrotic syndrome and hepatitis c infection was brought to hospital due to post-transplantation hyperglycemia. She underwent kidney transplantation from emotional-related living donor a month before admission. Pre-transplant data showed normal random and fasting plasma glucose. Immunosuppressive agents were given as post-transplant protocol, including tacrolimus, methylprednisolone, and mycophenolate acid. A month later, routine urinalysis check-up showed major glucosuria, and hyperglycemia. Laboratory findings revealed high true plasma glucose (617 mg/dL), HbA1C (11,2%), and ketonemia without acidosis. We diagnosed her with PTDM due to diabetogenic immunosuppressive agents, such as tacrolimus, and methylprednisolone, also HCV as additional risk factor. Immediate glucose control was done by giving continuous insulin, followed by basal-bolus regimen. Tacrolimus, and methylprednisolone dosage were decreased gradually during hospitalization, and after discharged at the out-patient basis. Monthly routine check-up showed improvement in glucose control, and gradual decrease of insulin requirement. Nine months after kidney transplantation, she no longer needed insulin, and resolved from PTDM. Tacrolimus and methylprednisolone dosage were decreased to 0,03 mg/kgBB/day, and 0,06 mg/kgBB/day. One year follow up showed maintained resolution status, with latest HbA1c of 4,9%. She gained normal nutritional status (body weight 45 kg, height 145 cm), menstrual cycle, and achieved better quality of life.
Learning Points/Discussion : Post-transplantation diabetes mellitus is one of serious complication of diabetogenic immunosuppressive agents and HCV infection. Dosage adjustment and insulin regimen need to be given to control blood glucose. Long term outcome of PTDM is excellent. Complete resolution was achieved 9 month after transplantation.
Keywords: diabetes mellitus post-transplant follow up