New‐onset diabetes after renal transplantation

Abstract

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.

Impact of renal transplantation on glucose tolerance in Japanese recipients with impaired glucose tolerance

“…This leads to the question of what are the factors affecting the improvement in glucose tolerance, insulin secretion and insulin sensitivity. Considering the risk factors for NODAT, recipient characteristics such as age, sex and the use of immunosuppression and glucocorticoids might affect glucose tolerance . In the present study, there were no differences in age, sex or glucocorticoid dosage between the non‐amelioration group and the amelioration group (Table ), and no significant differences in the changes in glucose tolerance were observed between the tacrolimus group and the cyclosporin A group (Tables S1 and S2).…”

“…In the present study, there were no differences in age, sex or glucocorticoid dosage between the non‐amelioration group and the amelioration group (Table ), and no significant differences in the changes in glucose tolerance were observed between the tacrolimus group and the cyclosporin A group (Tables S1 and S2). Although pre‐transplant weight and post‐transplant weight gain have significant impacts on the development of NODAT , no significant differences in BMI before or after transplantation were observed between the non‐amelioration group and the amelioration group (Table and Table S3). Also, tissue insensitivity to the action of insulin is reportedly present in people with advanced chronic renal failure and is the predominant factor contributing to glucose tolerance in uraemia ; however, no significant differences in renal function before and after transplantation were observed between the non‐amelioration group and the amelioration group (Table and Table S3).…”

The Effect of Different Glycaemic States on Renal Transplant Outcomes

“…Both DM and PTDM are inflammatory states [11] and hence increase the risk of DGF. However, hyperglycaemia may reflect rather than cause the inflammation.…”

Diabetic retinopathy in newly diagnosed diabetes after kidney and liver transplantation

“…4 Some but not all studies suggest that new-onset diabetes after transplantation has an adverse effect on graft survival and may increase cardiovascular morbidity and mortality, but little is known about the microvascular complications of this group of patients. 5 Screening for complications is recommended once diabetes has been diagnosed after transplantation. 6 Diabetes occurring after transplantation could provide a more precise date of onset of type 2 diabetes than is usually determined in ordinary clinical practice.…”