[Diabetes after transplantation].
In Europe, the incidence of new-onset post-transplantation diabetes significantly increases according to post-transplantation delay, ranging from 5% of the transplanted population after 6 months to 20% after 10 years. In this population, diabetes leads to serious cardiovascular complications, the risk of mortality markedly increasing with disease evolution. Therefore, the treatment of diabetes in these patients must be initiated as soon as possible. The main post-transplantation diabetes risk factors are hepatitis C seropositivity (HCV+), ethnicity, obesity and especially immunosuppressive treatments that increase insulin resistance (corticoids) or lower its secretion (calcineurin inhibitors). To reduce the risk of diabetes incidence in the patients at risk and especially HCV+ patients who are the most vulnerable, new treatment strategies have been developed, with the early discontinuation of corticoids and the optimization of immunosuppressive treatments, including associations of other therapeutic molecules such as mycophenolate mofetil or in some cases, drug conversions. However the therapeutic strategy must be carefully chosen taking into account the other cardiovascular risk factors and the grafts survival.
Durrbach
Antoine
A
Groupement hospitalier universitaire Sud, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre cedex, France. durrbach@wanadoo.fr
D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D005602:France / Q000453:epidemiology; D006084:Graft Rejection; D006526:Hepatitis C / Q000150:complications / Q000601:surgery; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects; D009765:Obesity / Q000150:complications; D016377:Organ Transplantation / Q000009:adverse effects*; D015995:Prevalence; D012307:Risk Factors
D007166:Immunosuppressive Agents