Post-transplant diabetes mellitus in Sudanese kidney transplant recipients: determinants and clinical outcomes from a retrospective cohort study

Background: Post-transplant diabetes mellitus (PTDM) is a common metabolic complication after kidney transplantation and has been linked to adverse long-term outcomes. Evidence from sub-Saharan Africa remains limited. This study assessed the frequency, associated factors, and post-transplant outcomes of PTDM in a Sudanese kidney transplant cohort. Methods: A retrospective cohort study was conducted among adult kidney transplant recipients followed at Dr Salma Centre for Kidney Diseases, Khartoum, Sudan. Recipients with documented pre-transplant diabetes were excluded from the PTDM analytic risk set. Clinical, transplant-related, treatment-related, and follow-up outcome variables were evaluated according to PTDM status. Factors associated with PTDM were examined using multivariable logistic regression, and associations between PTDM and post-transplant outcomes were assessed using modified Poisson regression with robust variance. Results: After exclusion of 152 recipients with pre-transplant diabetes, 640 recipients were included in the PTDM analytic cohort. PTDM was diagnosed during follow-up in 336 recipients (52.5%). After multivariable adjustment, higher odds of PTDM were observed for recipients older than 50 years at transplantation (OR 2.48, 95% CI 1.47–4.18), those with obesity (OR 3.12, 95% CI 1.76–5.53), pre-transplant ischemic heart disease (OR 1.58, 95% CI 1.03–2.43), tacrolimus-based therapy (OR 1.72, 95% CI 1.07–2.77), and maintenance corticosteroid exposure > 10 mg/day (OR 2.31, 95% CI 1.13–4.72). The estimate for dialysis duration > 30 months was weaker and did not reach conventional statistical significance (OR 1.41, 95% CI 0.97–2.06). PTDM was associated with a higher occurrence of post-transplant hypertension (RR 9.72), cardiovascular events (RR 6.18), dyslipidemia (RR 2.84), and infectious complications (RR 1.42). Graft failure and all-cause mortality were not statistically significant after adjustment. Conclusions: PTDM was frequently observed in this cohort and coincided with a higher burden of metabolic, cardiovascular, and infection-related outcomes. Future prospective studies using uniform PTDM screening and well-defined event dates are needed to clarify these relationships. Clinical trial registration: Not applicable. This was a retrospective observational study using routinely collected clinical and follow-up data.