Introduction: Cytomegalovirus (CMV) and BK are common viral infections in kidney transplant (KT) recipients that tend to appear within the first year after KT. Uncontrolled post-transplant diabetes mellitus (PTDM) and Type 2 diabetes mellitus (T2DM) have been associated with an increased risk for these opportunistic infections. This study aims to examine the association of CMV and/or BKA infections with CGM parameters like time in range (TIR) and GLP1-RA status.
Methods: This is a prospective follow-up study conducted at the Transplant Institute of the University of Alabama at Birmingham. We analyzed the data of 50 adults with PTDM and T2DM who underwent KT between 10/2022 to 10/2023. Patients were followed for 12 months for CMV and/or BKA new infections defined by positive serology. The association of TIR and GLP1-RA was reported as a risk ratio using univariable and multivariable modified poison regression analyses with standard error models adjusted for age, sex, race, and insulin type.
Results: Overall, 25 (50%) participants had CMV/BK infections. Mean age was 56.6 years, 56% were female, 66% African American, 70% with pre-existing type 2 diabetes, and 56% using GLP1-RA. Of the 19 participants with a TIR >70%, 3 (15.8%) experienced infection as compared to 22/32 (71.0%) with a TIR ≤70%. Of the 28 participants with GLP1-RA, 12 (42.9%) experienced infection as compared to 13/22 (59.1%) without GLP1-RA. Adjusting for confounders, risk of infections was lower for the participants with TIR >70% than those with ≤70% (RRadj=0.22, 95% CI: 0.07 - 0.66; p= 0.007) and for the participants with GLP1-RA than those without (RRadj = 0.77, 0.42 - 1.39; p=0.384).
Conclusion: KT patients with diabetes mellitus who were started on CGM for the first time, with a TIR >70% and GLP1-RA usage had a lower risk of transplant-related infections: BK and CMV. Early use of CGM with monitoring of TIR as a potential marker of diabetes control will improve transplant outcomes and rates of rejection.
M.S. Campana: None.
