644 - Defining Post-Kidney Transplant Diabetes Mellitus in Pediatric Recipients Across Transplant Centers

Kristy Zeng, Northwestern University The Feinberg School of Medicine, Chicago, IL, United States; Alexander J. Kula, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Debora Matossian, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Priya S. Verghese, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Stella Kilduff, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States

Background: Post-transplant diabetes mellitus (PTDM) is associated with poor pediatric kidney transplant (pKTx) graft and patient survival, but it has no approved definition. Additionally, risk factors, preventative strategies, and treatments for PTDM are not standardized. As such, our study aims to determine the variance in institutional definitions, diagnostic and management strategies as well as physician perceptions of PTDM.

Objective: Our study aims to determine the variance in institutional definitions, diagnostic and management strategies as well as physician perceptions of PTDM.

Design/Methods: A RedCap survey was created and distributed to pKTx nephrologists to all participant transplant centers in the Pediatric Nephrology Research Consortium. The survey had three sections: 1) center definition, diagnosis, and management of PTDM, (2) beliefs and opinions on the diagnosis and management of PTDM, and (3) a set of splicer/dicer questions on pediatric PTDM patients in the last 5 years to assess feasibility for future studies. A descriptive analysis is presented.

Results: Of the 36 pKTx specialists from 29 institutions: 89.5% necessitate HbA1c > 6.5% to make a diagnosis of PTDM with 52.9% requiring additional criteria such as fasting plasma glucose>126 mg/dl, random plasma glucose > 200mg/dl, and/or insulin therapy. Upon diagnosis, pKtx with PTDM were managed with immunosuppression change in 58.8% of nephrologists: 50% reduced corticosteroids, 30% switched tacrolimus to cyclosporine, and 20% did both. Lastly, participating nephrologists almost universally recognized the importance of standardizing both the definition and treatment plan for PTDM.

Conclusion(s): pKTx nephrologists have diverse practice patterns in the diagnosis and management of PTDM. Almost universally, pKTx nephrologists identify a need for standardization in the definition and diagnosis and therapy of PTDM. This is impetus for rigorous scientific process by an expert group to create, implement and disseminate guidelines on the management of pediatric PTDM.

Importance of Definition and Treatment Plan for PTDM per Pediatric Nephrologists
DefinePTDM_Importance.pdfParticipating pKTx nephrologists were asked how important defining and standardizing a treatment plan for PTDM was to them. The distribution of responses are seen in the figure above.