Novel views on new-onset diabetes after transplantation: development, prevention and treatment

被引:99
作者
Hecking, Manfred [1 ]
Werzowa, Johannes [1 ]
Haidinger, Michael [1 ]
Hoerl, Walter H. [1 ]
Pascual, Julio [2 ]
Budde, Klemens [3 ]
Luan, Fu L. [4 ]
Ojo, Akinlolu [4 ]
de Vries, Aiko P. J. [5 ,6 ]
Porrini, Esteban [7 ,8 ]
Pacini, Giovanni [9 ]
Port, Friedrich K. [10 ]
Sharif, Adnan [11 ]
Saeemann, Marcus D. [1 ]
机构
[1] Med Univ Vienna, Dept Internal Med, Clin Div Nephrol & Dialysis, Vienna, Austria
[2] Hosp del Mar, Serv Nephrol, Barcelona, Spain
[3] Dept Nephrol, Berlin, Germany
[4] Univ Michigan, Dept Internal Med, Div Nephrol, Ann Arbor, MI 48109 USA
[5] Leiden Univ, Dept Med, Med Ctr, Div Nephrol & Transplant Med, Leiden, Netherlands
[6] Leiden Univ, Leiden, Netherlands
[7] Univ La Laguna, Univ Hosp Canary Isl, Nephrol Sect, Tenerife, Canary Islands, Spain
[8] Univ La Laguna, Univ Hosp Canary Isl, Res Unit, Tenerife, Canary Islands, Spain
[9] CNR, Metab Unit, Inst Biomed Engn, Padua, Italy
[10] Arbor Res Collaborat Hlth, Ann Arbor, MI USA
[11] Queen Elizabeth Hosp, Renal Inst Birmingham, Birmingham B15 2TH, W Midlands, England
关键词
BETA-CELL FUNCTION; POLYCYSTIC KIDNEY-DISEASE; QUALITY-OF-LIFE; IMPAIRED GLUCOSE-TOLERANCE; RENAL-ALLOGRAFT RECIPIENTS; INTENSIVE INSULIN THERAPY; SUGAR-SWEETENED BEVERAGES; ALPHA-INTERFERON THERAPY; TERM GLYCEMIC CONTROL; C VIRUS-INFECTION;
D O I
10.1093/ndt/gfs583
中图分类号
R3 [基础医学]; R4 [临床医学];
学科分类号
1001 ; 1002 ; 100602 ;
摘要
New-onset diabetes after transplantation (NODAT) is associated with increased risk of allograft failure, cardiovascular disease and mortality, and therefore, jeopardizes the success of renal transplantation. Increased awareness of NODAT and the prediabetic states (impaired fasting glucose and impaired glucose tolerance, IGT) has fostered previous and present recommendations, based on the management of type 2 diabetes mellitus (T2DM). Unfortunately, the idea that NODAT merely resembles T2DM is potentially misleading, because the opportunity to initiate adequate anti-hyperglycaemic treatment early after transplantation might be given away for otailored' immunosuppression in patients who have developed NODAT or carry personal risk factors. Risk factor-independent mechanisms, however, seem to render postoperative hyperglycaemia with subsequent development of overt or ofull-blown' NODAT, the unavoidable consequence of the transplant and immunosuppressive process itself, at least in many cases. A proof of the concept that timely preventive intervention with exogenous insulin against post-transplant hyperglycaemia may decrease NODAT was recently provided by a small clinical trial, which is awaiting confirmation from a multicentre study. However, because early insulin therapy aimed at beta-cell protection seems to contrast the currently recommended, stepwise approach of owatchful waiting' prior to pancreatic decompensation, we here aim at reviewing recent concepts regarding the development, prevention and treatment of NODAT, some of which seem to challenge the traditional view on T2DM and NODAT. In summary, we suggest a novel, risk factor-independent management approach to NODAT, which includes glycaemic monitoring and anti-hyperglycaemic treatment in virtually everybody after transplantation. This approach has widespread implications for future research and is intended to tackle NODAT and also ultimately cardiovascular disease.
引用
收藏
页码:550 / 566
页数:17
相关论文
共 175 条
[1]   Contributions of β-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose [J].
Abdul-Ghani, MA ;
Tripathy, D ;
DeFronzo, RA .
DIABETES CARE, 2006, 29 (05) :1130-1139
[2]   Neoral® rescue therapy in transplant patients with intolerance to tacrolimus [J].
Abouljoud, MS ;
Kumar, MSA ;
Brayman, KL ;
Emre, S ;
Bynon, JS .
CLINICAL TRANSPLANTATION, 2002, 16 (03) :168-172
[4]  
[Anonymous], 1995, Diabetes, V44, P1249
[5]  
[Anonymous], 2007, LANCET, V370, P1101
[6]  
[Anonymous], 1994, Lancet, V344, P423
[7]  
[Anonymous], MEDICOGRAPHIA
[8]  
[Anonymous], TRANSPLANTATION
[9]  
[Anonymous], US REN DAT SYST USRD
[10]  
[Anonymous], KIDNEY RES CLIN PRAC