Post-Transplantation Diabetes Mellitus

Abstract

Solid organ transplantation (SOT) is an established therapeutic option for chronic disease resulting from end-stage organ dysfunction. Long-term use of immunosuppression is associated with posttransplantation diabetes mellitus (PTDM), placing patients at increased risk of infections, cardiovascular disease and mortality. The incidence rates for PTDM have varied from 10 to 40% between different studies. Diagnostic criteria have evolved over the years, as a greater understating of PTDM has been reached. There are differences in pathophysiology and clinical course of type 2 diabetes and PTDM. Hence, managing this condition can be a challenge for a diabetes physician, as there are several factors to consider when tailoring therapy for post-transplant patients to achieve better glycaemic as well as long-term transplant outcomes. This article is a detailed review of PTDM, examining the pathogenesis, diagnostic criteria and management in light of the current evidence. The therapeutic options are discussed in the context of their safety and potential drug-drug interactions with immunosuppressive agents.

Two Japanese patients with stage G3b chronic kidney disease and impaired glucose metabolism after renal transplantation successfully treated with empagliflozin

“…Little is currently known about the utility of administering SGLT2 inhibitors to patients after renal transplantation. In one study, Ahmed et al reported that there is no robust evidence to support the use of SGLT2 inhibitors in post-transplantation diabetes mellitus [8]. Here, however, we report two favorable outcomes with the SGLT2 inhibitor empagliflozin administered to patients with stage G3b CKD2 and impaired glucose metabolism following renal transplantation.…”

“…Between 2010 and 2017, the survival and engraftment rates were 97.1% and 94.1%, respectively, 5 years after living kidney transplantation. In addition, the 5-year survival and engraftment rate for renal donor transplants are also favorable at 93.1% and 87.9%, respectively [8]. Notably, Yagisawa et al reported that the cause of death for 16% of Japanese transplant recipients was heart disease [9].…”

“…According to the Japan Society for Clinical Renal Transplantation, among functional graft-related deaths, heart disease was the most common cause at a rate of 11.2-14.3% for all ages. Prior to transplantation, many renal transplant patients are undernourished due to pre-transplant diet therapy, renal insufficiency, CAPD, and hemodialysis [8,10]. After renal transplantation, the administration of steroids and immunosuppressants can lead to abnormalities in glucose metabolism.…”

“…In recent years, the incidence of diabetes as a primary disease has increased among kidney transplantation patients [9]. This is especially noteworthy because blood glucose control after transplantation is particularly important [8]. Following transplantation, transplant recipients often lead to overnutrition and weight gain, which becomes a risk for kidney graft loss [8,10].…”

“…This is especially noteworthy because blood glucose control after transplantation is particularly important [8]. Following transplantation, transplant recipients often lead to overnutrition and weight gain, which becomes a risk for kidney graft loss [8,10]. In addition, weight gain is an exacerbating factor contributing to abnormal glucose metabolism.…”