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

Abstract

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.

Differential risks for adverse outcomes 3 years after kidney transplantation based on initial immunosuppression regimen: a national study

“… recently reported that IL2R‐Abs and TMG were similar with respect to risk for overall cancer and viral‐related cancer, but TMG had a slightly higher risk for melanoma. The risk for NODAT has been shown in prior studies to increase with the use of Tac and with steroids ; consistently, we observed a reduced NODAT risk with CsA‐based and steroid‐free ISx compared with the reference regimen. We also observed a higher risk of NODAT when a three‐drug maintenance regimen of Tac + MPA/AZA + Pred was used without induction.…”

The Complex Roles of Mechanistic Target of Rapamycin in Adipocytes and Beyond

“…Mechanistically, rapamycin is an immunophillin that functions as an mTOR inhibitor only when bound to FKBP12. Patients on rapamycin often development new onset diabetes after transplantation (NODAT), which can increase post-transplant morbidity and mortality [159, 160]. The exact mechanisms by which NODAT develops is not understood [160–162].…”

Minimal Change Disease

“…However, published and personal experience suggest that TAC can be a good alternative to CsA in adolescents, especially girls, as it does not induce hypertrichosis or gingival hypertrophy, side effects to which these patients are very sensitive, thus improving therapeutic compliance. An oral glucose tolerance test before starting is prudential (52).…”