An update review of post-transplant diabetes mellitus: Concept, risk factors, clinical implications and management
Kanbay M. Copur S. Topçu A.U. Guldan M. Ozbek L. Gaipov A. Ferro C. Cozzolino M. Cherney D.Z.I. Tuttle K.R.
July 2024John Wiley and Sons Inc
Diabetes, Obesity and Metabolism
2024#26Issue 72531 - 2545 pp.
Objective: Kidney transplantation is the gold standard therapeutic alternative for patients with end-stage renal disease; nevertheless, it is not without potential complications leading to considerable morbidity and mortality such as post-transplant diabetes mellitus (PTDM). This narrative review aims to comprehensively evaluate PTDM in terms of its diagnostic approach, underlying pathophysiological pathways, epidemiological data, and management strategies. Methods: Articles were retrieved from electronic databases using predefined search terms. Inclusion criteria encompassed studies investigating PTDM diagnosis, pathophysiology, epidemiology, and management strategies. Results: PTDM emerges as a significant complication following kidney transplantation, influenced by various pathophysiological factors including peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways. Despite discrepancies in prevalence estimates, PTDM poses substantial challenges to transplant. Diagnostic approaches, including traditional criteria such as fasting plasma glucose (FPG) and HbA1c, are limited in their ability to capture early PTDM manifestations. Oral glucose tolerance test (OGTT) emerges as a valuable tool, particularly in the early post-transplant period. Management strategies for PTDM remain unclear, within sufficient evidence from large-scale randomized clinical trials to guide optimal interventions. Nevertheless, glucose-lowering agents and life style modifications constitute primary modalities for managing hyperglycemia in transplant recipients. Discussion: The complex interplay between PTDM and the transplant process necessitates individualized diagnostic and management approaches. While early recognition and intervention are paramount, modifications to maintenance immunosuppressive regimens based solely on PTDM risk are not warranted, given the potential adverse consequences such as increased rejection risk. Further research is essential to refine management strategies and enhance outcomes for transplant recipients.
diabetes mellitus , glucose-lowering drugs , immunosuppression , solid organ transplantation
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Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
Department of Medicine, School of Medicine, Nazarbayev University, Astana, Kazakhstan
Department of Nephrology, University Hospitals Birmingham and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
Department of Health Sciences, Renal Division, University of Milan, Milan, Italy
Department of Medicine, Division of Nephrology, University Health Network, Toronto, ON, Canada
Department of Medicine, Division of Nephrology, University of Washington, Seattle, WA, United States
Division of Nephrology
Department of Medicine
Department of Medicine
Department of Nephrology
Department of Health Sciences
Department of Medicine
Department of Medicine
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