OBJECTIVE — To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS — We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS — Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower (10% in most studies) than it was 3 decades ago. The type of immunosuppression explained 74% of the variability in incidence (P 0.0004). Risk factors were patient age, nonwhite ethnicity, glucocorticoid treatment for rejection, and immunosuppression with high-dose cyclosporine and tacrolimus. PTD was associated with decreased graft and patient survival in earlier studies; later studies showed improved outcomes. Randomized trials of treatment regimens have not been conducted. CONCLUSIONS — Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs. Diabetes Care 25:583–592, 2002

A systematic review of the literature

Phantom auditory perception (tinnitus): mechanisms of generation and perception

https://onlinelibrary.wiley.com/doi/pdf/10.1034/j.1600-6143.2003.00010.x

Diabetes Mellitus after Kidney Transplantation in the United States

OBJECTIVES— To systematically review the incidence of posttransplantation diabetes (PTD), risk factors for its development, prognostic implications, and optimal management. RESEARCH DESIGN AND METHODS— We searched databases (MEDLINE, EMBASE, the Cochrane Library, and others) from inception to September 2000, reviewed bibliographies in reports retrieved, contacted transplantation experts, and reviewed specialty journals. Two reviewers independently determined report inclusion (original studies, in all languages, of PTD in adults with no history of diabetes before transplantation), assessed study methods, and extracted data using a standardized form. Meta-regression was used to explain between-study differences in incidence. RESULTS— Nineteen studies with 3,611 patients were included. The 12-month cumulative incidence of PTD is lower ( CONCLUSIONS— Physicians should consider modification of immunosuppressive regimens to decrease the risk of PTD in high-risk transplant recipients. Randomized trials are needed to evaluate the use of oral glucose-lowering agents in transplant recipients, paying particular attention to interactions with immunosuppressive drugs.

https://care.diabetesjournals.org/content/diacare/25/3/583.full.pdf

Posttransplantation diabetes: a systematic review of the literature.

Nonadherence to immunosuppressants is recognized to occur after renal transplantation, but the size of its impact on transplant survival is not known. A systematic literature search identified 325 studies (in 324 articles) published from 1980 to 2001 reporting the frequency and impact of nonadherence in adult renal transplant recipients. Thirty-six studies meeting the inclusion criteria for further review were grouped into cross-sectional and cohort studies and case series. Meta-analysis was used to estimate the size of the impact of nonadherence on graft failure. Only two studies measured adherence using electronic monitoring, which is currently thought to be the most accurate measure. Cross-sectional studies (n=15) tended to rely on self-report questionnaires, but these were poorly described; a median (interquartile range) of 22% (18%-26%) of recipients were nonadherent. Cohort studies (n=10) indicated that nonadherence contributes substantially to graft loss; a median (interquartile range) of 36% (14%-65%) of graft losses were associated with prior nonadherence. Meta-analysis of these studies showed that the odds of graft failure increased sevenfold (95% confidence interval, 4%-12%) in nonadherent subjects compared with adherent subjects. Standardized methods of assessing adherence in clinical populations need to be developed, and future studies should attempt to identify the level of adherence that increases the risk of graft failure. However, this review shows nonadherence to be common and to have a large impact on transplant survival. Therefore, significant improvements in graft survival could be expected from effective interventions to improve adherence.

Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review.

Objective:Develop dose-response relations for two groups of industrial workers exposed to Gaussian or non-Gaussian (complex) types of continuous noises and to investigate what role, if any, the kurtosis statistic can play in the evaluation of industrial noise-induced hearing loss (NIHL).Design:Audio

Application of the kurtosis statistic to the evaluation of the risk of hearing loss in workers exposed to high-level complex noise.

Industrial noise environments usually present a complex stimulus to the exposed individual These environments often contain mixtures of multiply reflected impact noises and a relatively Gaussian broadband noise Noise exposure standards do not consider the possibility of interactions between the two classes of noise that can exacerbate the amount of hearing trauma This paper presents the results of a large series of experiments designed to document the hazard posed to hearing from complex noise exposures Twenty-three groups of chinchillas with 5 to 11 animals per group (total N = 135) were exposed for 5 days to either octave bands of noise, impacts alone, or combinations of impact and octave bands of noise Evoked potential measures of hearing thresholds and cochleograms were used to quantify the noise-induced trauma The results show that, for sound exposure levels (SEL) which produce less than approximately 10 dB PTS (permanent threshold shift) or 5% total sensory cell loss, equal-energy exposures tend to produce equivalent effects on hearing However, there is a range of at least 10 dB in the SEL parameter where hearing loss from equal-energy exposures at a particular SEL can be exacerbated by increasing the repetition rate of the impacts or by the addition of a Gaussian low-level noise The exacerbation of trauma from the addition of a Gaussian continuous noise is dependent upon the spectrum of that noise

Complex noise exposures: An energy analysis

A worldwide shortage of cadaveric donors has led to the increased utilization of elderly living donors, with controversial results. In an attempt to assess the effect of donor age on graft survival and subsequent renal function, we analyzed our clinical results in 276 consecutive recipients of living related renal transplants spanning both the cyclosporine and the azathioprine eras, of whom a total of 44 recipients received kidneys from donors over 55 years old. All recipients were otherwise similar in age, race, haplotype mismatch, number of retransplants, and number of pretransplant transfusions, apart from an increased number of diabetics among the CsA-treated recipients of elderly kidneys (38% vs. 14%). The cumulative patient and graft survival rates at 1 and 5 years were independent of donor age whether CsA or AZA was utilized. Nor was the incidence of rejection or infection significantly different in the older donor group when compared with the younger cohort. Short-term and intermediate-term renal function, as assessed by serum creatinine, was however poorer but stable in the older donor group when compared with the younger one. The mean serum creatinine levels at 1 year in the CsA- and AZA-treated recipients of kidneys from older donors were 2.4 and 2.0 mg/dl, respectively, compared with 1.6 and 1.4 mg/dl, respectively, when the donor age was less than 55 years (P less than 0.001). Since renal function at the end of the first posttransplant year is considered a determinant of long-term graft survival, this is a cause for concern, but in view of the universal shortage of organs and the negligible morbidity to donors, renal transplantation from elderly living donors remains an acceptable practice.

Renal transplantation from elderly living donors.

Posttransplant diabetes mellitus in cyclosporine-treated renal transplant recipients.

A single center experience of 514 ciclosporin-treated renal allografts which survived longer than 1 year was reviewed in order to analyze the causes of renal allograft loss beyond the 1st year post-tr

Robert I. Davis

Papers

Application of the kurtosis statistic to the evaluation of the risk of hearing loss in workers exposed to high-level complex noise.

Complex noise exposures: An energy analysis

Renal transplantation from elderly living donors.

Posttransplant diabetes mellitus in cyclosporine-treated renal transplant recipients.

Causes of late renal allograft failure in the ciclosporin era