New-onset diabetes mellitus after kidney transplantation: Current status and future directions

被引:92
作者
Palepu, Sneha [1 ]
Prasad, G. V. Ramesh [1 ]
机构
[1] Univ Toronto, St Michaels Hosp, Div Nephrol, Toronto, ON M5C 2T2, Canada
关键词
Cyclosporine; Graft; Kidney; New-onset diabetes; Tacrolimus; Transplantation;
D O I
10.4239/wjd.v6.i3.445
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A diagnosis of new-onset diabetes after transplantation (NODAT) carries with it a threat to the renal allograft, as well as the same short-and long-term implications of type 2 diabetes seen in the general population. NODAT usually occurs early after transplantation, and is usually diagnosed according to general population guidelines. Non-modifiable risk factors for NODAT include advancing age, African American, Hispanic, or South Asian ethnicity, genetic background, a positive family history for diabetes mellitus, polycystic kidney disease, and previously diagnosed glucose intolerance. Modifiable risk factors for NODAT include obesity and the metabolic syndrome, hepatitis C virus and cytomegalovirus infection, corticosteroids, calcineurin inhibitor drugs (especially tacrolimus), and sirolimus. NODAT affects graft and patient survival, and increases the incidence of post-transplant cardiovascular disease. The incidence and impact of NODAT can be minimized through pre- and post-transplant screening to identify patients at higher risk, including by oral glucose tolerance tests, as well as multi-disciplinary care, lifestyle modification, and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin. Since NODAT is a major cause of post-transplant morbidity and mortality, measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.
引用
收藏
页码:445 / 455
页数:11
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