Guidelines for the treatment and management of new‐onset diabetes after transplantation¹

Abstract

Although graft and patient survival after solid organ transplantation have improved markedly in recent years, transplant recipients continue to experience an increased prevalence of cardiovascular disease (CVD) compared with the general population. A number of factors are known to impact on the increased risk of CVD in this population, including hypertension, dyslipidemia and diabetes mellitus. Of these factors, new-onset diabetes after transplantation has been identified as one of the most important, being associated with reduced graft function and patient survival, and increased risk of graft loss. In 2003, International Consensus Guidelines on New-onset Diabetes after Transplantation were published, which aimed to establish a precise definition and diagnosis of the condition and recommend management strategies to reduce its occurrence and impact. These updated 2004 guidelines, developed in consultation with the International Diabetes Federation (IDF), extend the recommendations of the previous guidelines and encompass new-onset diabetes after kidney, liver and heart transplantation. It is hoped that adoption of these management approaches pre- and post-transplant will reduce individuals' risk of developing new-onset diabetes after transplantation as well as ameliorating the long-term impact of this serious complication.

Should an Oral Glucose Tolerance Test Be Performed Routinely in All Renal Transplant Recipients?

“…The consensus guidelines advise that screening for disorders of glucose homeostasis in established (Ͼ1 yr) RTR should be performed on an annual basis, in keeping with current American Society of Transplantation recommendations (16). The oral glucose tolerance test (OGTT) is not recommended as a screening tool in RTR, although it is suggested that it should be performed in all RTR with FBG of Ն110 mg/dl (6.1 mmol/L) (17). In liver transplant recipients, the OGTT has been advocated as an annual screening tool in all individuals with a normal FBG (18).…”

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

“…22 Per the 2003 International Consensus Guidelines for new-onset diabetes after transplant, weekly fasting plasma glucose screening is recommended for the first month after OLT, followed by screening at 3, 6, and 12 months and annually thereafter. 29,30 Hemoglobin A 1c may not be accurate in the early posttransplant period owing to anemia and high red blood cell turnover. The diagnosis of diabetes is the same as in the general population.…”

Cardiac Allograft Vasculopathy: A Review of Risk Factors and Pathogenesis

“…Some studies have shown higher incidence of infection in diabetic cardiac transplant patients compared to nondiabetic patients [129]. Discrepancies in the results of these studies are attributed to the limitations including defining criteria for the diagnosis of diabetes, therapeutic regimen used for the management of diabetes, target glycemic control and presence of any associated micro or macrovascular complications of diabetes [131,137,138]. Further studies are required to define the therapeutic targets and impact of glycemic control on development and prognosis of CAV.…”