Dysglycemia after renal transplantation: Definition, pathogenesis, outcomes and implications for management

World Journal of Diabetes
David Langsford, Karen Dwyer

Abstract

New-onset diabetes after transplantation (NODAT) is major complication following renal transplantation. It commonly develops within 3-6 mo post-transplantation. The development of NODAT is associated with significant increase in risk of major cardiovascular events and cardiovascular death. Other dysglycemic states, such as impaired glucose tolerance are also associated with increasing risk of cardiovascular events. The pathogenesis of these dysglycemic states is complex. Older recipient age is a consistent major risk factor and the impact of calcineurin inhibitors and glucocorticoids has been well described. Glucocorticoids likely cause insulin resistance and calcineurin inhibitors likely cause β-cell toxicity. The impact of transplantation in incretin hormones remains to be clarified. The oral glucose tolerance test remains the best diagnostic test but other tests may be validated as screening tests. Possibly, NODAT can be prevented by administering insulin early in patients identified as high risk for NODAT. Once NODAT has been diagnosed altering immunosuppression may be acceptable, but creates the difficulty of balancing immunological with metabolic risk. With regard to hypoglycemic use, metformin may be the best option. Fur...Continue Reading

Citations

Aug 10, 2016·Diabetic Medicine : a Journal of the British Diabetic Association·A NakamuraT Atsumi
Mar 23, 2017·The Journal of Clinical Endocrinology and Metabolism·Jarno L T KettunenTiinamaija Tuomi
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Jun 14, 2016·Therapeutic Advances in Endocrinology and Metabolism·Oluwatoyin Bamgbola
Mar 2, 2018·Transplantation·Leyla J AouadSteven J Chadban
Sep 29, 2018·Expert Opinion on Drug Metabolism & Toxicology·Débora Dias De Lucena, Érika Bevilaqua Rangel
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Nov 17, 2020·Expert Review of Clinical Pharmacology·Eloi ChevallierJohan Noble

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