Renal transplantation has important benefits in people with end-stage renal disease, with improvements in mortality, morbidity and quality of life. Whilst significant advances in transplantation techniques and immunosuppressive regimens have led to improvements in short-term outcomes, longer-term outcomes have not improved dramatically. New-onset diabetes after transplantation appears to be a major factor in morbidity and cardiovascular mortality in renal transplant recipients. The diagnosis of new-onset diabetes after renal transplantation has been hampered by a lack of clarity over diagnostic tests in early studies, although the use of the WHO criteria is now generally accepted. HbA1c may be useful diagnostically, but should probably be avoided in the first 3 months after transplantation. The pathogenesis of new-onset diabetes after renal transplantation is likely to be related to standard pathogenic factors in Type 2 diabetes (e.g. insulin resistance, β-cell failure, inflammation and genetic factors) as well as other factors, such as hepatitis C infection, and could be exacerbated by the use of immunosuppression (glucocorticoids and calcineurin inhibitors). Pre-transplant risk scores may help identify those people at risk of new-onset diabetes after renal transplantation. There are no randomized trials of treatment of new-onset diabetes after renal transplantation to determine whether intensive glucose control has an impact on cardiovascular or renal morbidity, therefore, treatment is guided by guidelines used in non-transplant diabetes. Many areas of uncertainty in the pathogenesis, diagnosis and management of new-onset diabetes after renal transplantation require further research.

This is the final article in a three-part education series on renal transplantation, which addresses the specialist knowledge required in the long-term management of the people undergoing renal transplantation. The first article in this series (Murphy F., Trevitt R., Chamney M. et al. (2011). Patient health and well-being while waiting for renal transplantation: Part 1. Journal of Renal Care 37(4), 224-231) addressed patient health and well being while waiting for a renal transplant. The second article (Trevitt R., Dunsmore V., Murphy F., Piso L., Perriss C., Englebright B. & Chamney M. (2012) Pre- and post-transplant care: nursing management of the renal transplant recipient: Part 2. Journal of Renal Care 38(2), 107-114) examined pre- and post-operative care and management.