Post-transplant diabetes mellitus in patients with solid organ transplants

Jenssen, Trond; Hartmann, Anders

doi:10.1038/s41574-018-0137-7

Cited by 189 publications

(196 citation statements)

References 187 publications

Supporting

Mentioning

186

Contrasting

Unclassified

Order By: Relevance

“…These results are in accordance with those provided by Ye et al [5], where cumulative rates of PTDM were 11.1, 32.0 and 38.4% after 12-, 24-and 36-months post HT respectively [5]. With the documented time-dependent increase in incidence of PTDM after HT, it is clear that other factors in addition to glucocorticoids, in particular CNIs, are involved in its pathogenesis, and that this entity differs from steroid DM [30]. CNIs decrease insulin release by direct toxic effect on pancreatic β-cells.…”

Section: Discussionsupporting

confidence: 91%

Endocrine disorders after heart transplantation: national cohort study

et al. 2020

View full text Add to dashboard Cite

Background: Endocrine disorders in patients after heart transplantation (HT) remain understudied. We aimed to assess endocrine profiles and management of HT recipients in the early post-transplant period. Methods: We conducted a retrospective cohort study on 123 consecutive HT recipients in the Advanced Heart Failure and Transplantation Programme between 2009 and 2018. All recipients had per-protocol endocrine followup within the first postoperative year. The median time to first post-transplant endocrine follow-up was 3 months (IQR 2-4). We assessed the incidence of vitamin D deficiency, bone mineral density, history of low energy fractures, hypogonadism in male recipients, posttransplant diabetes mellitus, and thyroid and parathyroid function. Results: We enrolled 22 women and 101 men of median age 57 years (IQR 50-63). Post-transplant diabetes mellitus developed in 14 patients (11.4%). 18 of 25 patients (14.6%) with preexisting type 2 diabetes mellitus required intensification of antidiabetic therapy. 38 male patients (40.4%) had hypogonadism. 5 patients (4.6%) were hypothyroid and 10 (9.3%) latent hyperthyroid. Secondary hyperparathyroidism was present in 19 (17.3%), 25hydroxyvitamin D deficiency in 64 (54.7%) of patients. Osteoporosis was present in 26 (21.1%), osteopenia in 59 (48.0%) patients. 47 vertebral fractures, 3 hip and 1 humerus fractures occurred in 21 patients. Most of the patients had coincidence of two or three disorders, while less than 5% did not have any endocrine irregularities. All patients received calcium and vitamin D supplements. Forty-six patients (37.4%) were treated with zoledronic acid, 12 (9.8%) with oral bisphosphonates. Two patients were treated with teriparatide. Conclusions: The prevalence of multiple endocrine disorders early after heart transplantation is high. Assessment and management of increased fracture risk and all other potentially affected endocrine axes should be considered as a standard of care in this early period.

show abstract

Section: Discussionsupporting

confidence: 91%

Endocrine disorders after heart transplantation: national cohort study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…PTDM is an important risk factor for solid organ transplant recipients and is strongly associated with mortality and graft loss in recipients 4,8 . Currently, the reasonable first step for prevention of PTDM is assessment and elimination of the risk factors for patients with high‐risk diabetes after transplantation 27 . A randomized controlled trial indicated that new‐onset diabetes after transplant (NODAT) was reported to occur in 33.6% of organ recipients with the use of tacrolimus, higher than the percentage observed with cyclosporin A (26.0%, P < .05) 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Tacrolimus is an important risk factor for PTDM, similar to family history of diabetes, central obesity, and impaired fasting blood glucose. The recipients with these risk factors are more likely to develop PTDM 27,28 . However, in some conditions, it is obviously difficult to remove these risk factors, while tacrolimus might also be necessary.…”

Section: Discussionmentioning

confidence: 99%

Butyric acid normalizes hyperglycemia caused by the tacrolimus-induced gut microbiota

Jiao

Zhang

et al. 2020

American Journal of Transplantation

View full text Add to dashboard Cite

Approximately 33.6% of nondiabetic solid organ transplant recipients who received tacrolimus developed hyperglycemia. Whether the tacrolimus‐induced gut microbiota is involved in the regulation of hyperglycemia has not been reported. Hyperglycemia was observed in a tacrolimus‐treated mouse model, with reduction in taxonomic abundance of butyrate‐producing bacteria and decreased butyric acid concentration in the cecum. This tacrolimus‐induced glucose metabolic disorder was caused by the gut microbiota, as confirmed by a broad‐spectrum antibiotic model. Furthermore, oral supplementation with butyrate, whether for remedy or prevention, significantly increased the butyric acid content in the cecum and arrested hyperglycemia through the regulation of glucose‐regulating hormones, including glucagon‐like peptide‐1 (GLP‐1), peptide YY (PYY), and insulin, in serum. The butyrate–G‐protein‐coupled receptor 43–GLP‐1 pathway in the intestinal crypts may be involved in the pathogenesis of normalization of hyperglycemia caused by the tacrolimus. Therefore, tacrolimus affects glucose metabolism through the butyrate‐associated GLP‐1 pathway in the gut, and oral supplementation with butyrate provides new insights for the prevention and treatment of tacrolimus‐induced hyperglycemia in transplant recipients.

show abstract

“…PTDM is characterized by a combination of insulin resistance and decompensated insulin release, which is similar to type 2 DM (22). Various risk factors including unmodifiable (i.e., older age, genetic background, family history of DM) and modifiable (i.e., central obesity, immunosuppressive agents, hepatitis C infection, and smoking) risk factors have been implicated for the development of PTDM in previous studies (8,23,24).…”

Section: Discussionmentioning

confidence: 99%

Association Between Pre-Transplant Magnesemia and Post-Transplant Dysglycemia in Kidney Transplant Recipients

Alamdari

Asadi

Minoo

et al. 2020

Int J Endocrinol Metab

View full text Add to dashboard Cite

Background: Serum magnesium (Mg) status in kidney transplant recipients has been a center of attention in the past few years. Current evidence suggests an association between pre-transplant hypomagnesemia and post-transplant hyperglycemia. Objective: The purpose of this study was to assess the associations of pre-transplant magnesemia with blood glucose disturbances within 6 months post-kidney transplantation. Methods: In this retrospective cohort, 89 first-time kidney transplant recipients with 6 months of follow-up were included. None of the participants had a positive history of rejection, pre-transplant history of diabetes mellitus or fasting plasma glucose ≥ 100 mg/dL. Results: Post-transplant diabetes mellitus (PTDM) and impaired fasting glucose (IFG) 6 months post-transplant was found in 7.9% and 41.6% of the study group, respectively. The mean pre-transplant serum Mg level was 1.92 ± 0.30 mg/dL in the study population (n = 89), and it was significantly lower in IFG (n = 37) and IFG/PTDM (n = 44) groups compared to normoglycemic (n = 45) recipients (1.83 ± 0.31 mg/dL vs. 2.00 ± 0.27 mg/dL, P = 0.008, and 1.84 ± 0.31 mg/dL vs. 2.00 ± 0.27 mg/dL, P = 0.012, respectively). Patients with serum Mg less than 1.9 mg/dL were nearly 2.6 times more likely to develop IFG or IFG/PTDM within 6 months post-transplant (P = 0.044 and P = 0.040, respectively). Conclusions: Pre-transplant hypomagnesemia may be considered a risk factor for developing post-transplant glycemic disturbances, and patients with lower pre-transplant Mg concentration could be at a higher risk for developing IFG.

show abstract

Post-transplant diabetes mellitus in patients with solid organ transplants

Cited by 189 publications

References 187 publications

Endocrine disorders after heart transplantation: national cohort study

Endocrine disorders after heart transplantation: national cohort study

Butyric acid normalizes hyperglycemia caused by the tacrolimus-induced gut microbiota

Association Between Pre-Transplant Magnesemia and Post-Transplant Dysglycemia in Kidney Transplant Recipients

Contact Info

Product

Resources

About