Post-transplant diabetes: incidence, relationship to choice of immunosuppressive drugs, and treatment protocol.
Post-transplant diabetes mellitus (PTDM) is one of the feared complications of immunosuppressive therapy. Despite advances, including the introduction of the steroid-sparing calcineurin inhibitors, cyclosporine and tacrolimus, the incidence rate remains greater than 10% to 30%, especially in minority populations. PTDM increases the subsequent risk of both graft loss and patient death, and predisposes patients to all complications of diabetes, including retinopathy and neuropathy. Patients should be monitored closely, especially during the first 3 months post-transplant, and treated aggressively, should glucose intolerance be detected. Minimization of immunosuppression dose, diet, oral hypoglycemic agents, and insulin have all been used in the treatment of PTDM, however, the insulin-sensitizing agents have not been studied. It is hoped that newer immunosuppressive regimens and, ultimately, the ability to achieve tolerance will eventually solve the problem of PTDM.
Markell
M S
MS
Division of Transplant Nephrology, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA. mmarkell@hscbklyn.edu
D003928:Diabetic Nephropathies / Q000139:chemically induced* / Q000453:epidemiology*; D006084:Graft Rejection / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D011183:Postoperative Complications / Q000139:chemically induced / Q000453:epidemiology
D007166:Immunosuppressive Agents