Posttransplant Diabetes Mellitus: Cause, Impact, and Treatment Options

Abstract

The incidence of diabetes mellitus (DM) is increased in adult organ transplant recipients. As many as 30% to 45% of solid organ adult transplant patients have DM before transplantation or develop posttransplant diabetes mellitus (PTDM). Risk factors for PTDM include family history, ethnic or genetic background, insulin resistance, and diabetogenic effects of immunosuppressive medications. Posttransplant hyperglycemia may result in increased platelet aggregation, increased wound infections, dehydration, and loss of lean body mass. More significantly, long-term complications of DM such as coronary artery disease and peripheral vascular disease may be exacerbated with the use of immunosuppressive medications whose known side effects include hyperglycemia, hyperlipidemia, and hypertension; these effects may lead to premature transplant graft dysfunction. Treatment goals for PTDM reflect those of the American Diabetes Association guidelines; long-term management is linked with early, patient-centered education and optimizing minimally diabetogenic immunosuppressive medication regimens. A multidisciplinary team including the patient, family/support people, transplant surgeon, transplant physician, transplant nurse coordinator, transplant social worker, pharmacist, dietitian, and diabetes educator is crucial to long-term management of PTDM.

Cardiovascular disease in the kidney transplant recipient: epidemiology, diagnosis and management strategies

“…Additional weight gain post-KT is common, with an average weight gain of 5-10% in the first year, with age >45 years, female gender, African American ethnicity and preexisting obesity associated with highest risk [59]. The relationship between obesity and metabolic syndrome/PTDM after KT is complex and represents the confluence of preexisting metabolic risk with the superimposed effects of immunosuppressive regimens that may complicate glycemic control [60,61]. For KT candidates, lifestyle changes should be strongly encouraged, with a role for bariatric surgery in selected patients to make otherwise good transplant candidates acceptable for the KT wait list.…”