New onset diabetes after kidney transplantation in Asian Americans – Is there an increased risk?

New-onset diabetes after transplantation (NODAT) is increasing in frequency and creates many challenges directly impacting the patient and graft survival. Most transplant programs offer a fixed-dose prednisone taper schedule for the prevention of acute rejection following kidney transplantation. In this study, we investigated the incidence of NODAT in new kidney transplant recipients. Methods: This was a retrospective, single-center study assessing rates of NODAT according to age, ethnicity, body weight, BMI, rejection, and prednisone dosing among kidney transplant recipients. Results: Among non-diabetic consecutive kidney transplant recipients (n = 261) from 1/2014 to 12/2018, a total of 47 (18%) kidney transplant recipients developed NODAT. After adjusting for common NODAT risk factors, analysis of the population indicated that age, and corticosteroid dose in the Asian American population [adjusted for lower body weight, BMI] significantly increased the risk of NODAT. In multi-variance analysis, despite receiving lower standard doses of protocol corticosteroid daily, when adjusted for actual body weight (mg/kg/day) Asian American recipients had high incidence of NODAT compared to other ethnicity. Asian American received higher doses or corticosteroids (prednisone) than non-Asian Americans (0.14 mg/kg vs. 0.11 mg/kg) (p = 0.008). The overall incidence of rejection was not higher among those who developed NODAT (p = 0.55) Conclusion: This is the first study to explore the relationship between corticosteroid dose and diabetes in Asian Americans. Asian Americans had higher rates of NODAT and received higher doses of weight-based corticosteroids. There is a possible iatrogenic, pharmacogenomic, and addressable etiology to NODAT in this population.