Skip to main content

Advertisement

SpringerLink
Log in

Diagnosis and approach to posttransplant diabetes

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

The availability of new immunosuppressive drugs has led to improvement in outcome for transplanted patients, but these drugs have also led to the increase of metabolic abnormalities, such as dyslipidemia and hyperglycemia, which can affect graft and patient outcome. Posttransplant diabetes mellitus (PTDM) or new-onset diabetes after transplantation is defined as the onset of diabetes in previously nondiabetic transplant recipients. Several clinical studies have demonstrated the involvement of PTDM in death due to infectious and cardiovascular disease. This article reviews recent concepts on pathophysiology, diagnosis, and treatment of PTDM.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kasiske BL, Snyder JJ, Gilbertson D, Matas AJ: Diabetes mellitus after kidney transplantation in the United States. Am J Transplant 2003, 3:178–185.

    Article  PubMed  Google Scholar 

  2. Joss N, Staatz CE, Thomson AH, Jardine AG: Predictors of new onset diabetes after renal transplantation. Clin Transplant 2007, 19:136–143.

    Article  Google Scholar 

  3. Miles AM, Sumrani N, Horowitz R, et al.: Diabetes mellitus after renal transplantation: as deleterious as non-transplant-associated diabetes? Transplantation 1998, 65:380–384.

    Article  PubMed  CAS  Google Scholar 

  4. Hjelmesaeth J, Hartmann A, Leivestad T, et al.: The impact of early-diagnosed new-onset post-transplantation diabetes mellitus on survival and major cardiac events. Kidney Int 2006, 69:588–595.

    Article  PubMed  CAS  Google Scholar 

  5. Pham PT, Pham PC, Lipshutz GS, Wilkinson AH: New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin North Am 2007, 36:873–890.

    Article  PubMed  CAS  Google Scholar 

  6. John PR, Thuluvath PJ: Outcome of patients with new onset diabetes mellitus after liver transplantation compared with those without diabetes mellitus. Liver Transpl 2002, 8:708–713.

    Article  PubMed  Google Scholar 

  7. Vincenti F, Friman S, Scheuermann E, et al., on behalf of the DIRECT (Diabetes Incidence after Renal Transplantation: Neoral C2 Monitoring Versus Tacrolimus) Investigators: Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transpl 2007, 7:1506–1514.

    Article  CAS  Google Scholar 

  8. Montori VM, Basu A, Erwin PJ, et al.: Posttransplantation diabetes: a systematic review of the literature. Diabetes Care 2002, 25:583–592.

    Article  PubMed  Google Scholar 

  9. Kamar N, Mariat C, Delahousse M, et al., on behalf of the Diapason Study Group: New onset diabetes mellitus incidence and risk factors in kidney transplantation: results of the observational cross-sectional study diapason. Transpl Proc 2006, 38:2295–2297.

    Article  CAS  Google Scholar 

  10. Ollech JE, Kramer MR, Peled N, et al.: Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors. Eur J Cardiothorac Surg 2008, 33:844–848.

    Article  PubMed  Google Scholar 

  11. Midtvedt K, Hjelmesaeth J, Hartmann A, et al.: Insulin resistance after renal transplantation: the effect of steroid dose reduction and withdrawal. J Am Soc Nephrol 2004, 15:3233–3239.

    Article  PubMed  Google Scholar 

  12. Goldberg PA: Comprehensive management of post-transplant diabetes mellitus: from intensive care to home care. Endocrinol Metab Clin North Am 2007, 36:907–922.

    Article  PubMed  CAS  Google Scholar 

  13. Bayès B, Granada ML, Pastor MC, et al.: Obesity, adiponectin and inflammation as predictors of new-onset diabetes mellitus after kidney transplantation. Am J Transpl 2007, 7:416–422.

    Article  Google Scholar 

  14. Doyle ME, Egan MJ: Pharmacological agents that directly modulate insulin secretion. Pharmacol Rev 2007, 55:105–131.

    Article  Google Scholar 

  15. Arner P, Gunnarson R, Blomdahl S, Groth CG: Some characteristics of steroid diabetes: a study in renal-transplant recipients receiving high dose corticosteroid therapy. Diabetes Care 1983, 6:23–25.

    Article  PubMed  CAS  Google Scholar 

  16. American Diabetes Association: Diagnosis and classification of diabetes mellitus. Diabetes Care 2007, 30(Suppl 1):S42–S47.

    Article  Google Scholar 

  17. Andrews RC, Walker BR: Glucocorticoids and insulin resistance: Old hormones, new targets. Clin Sci 1999, 96:513–523.

    Article  PubMed  CAS  Google Scholar 

  18. Delaunay F, Khan A, Cintra A, et al.: Pancreatic beta cells are important targets for the diabetogenic effects of glucocorticoids. J Clin Invest 1997, 100:2094–2098.

    Article  PubMed  CAS  Google Scholar 

  19. Crabtree GR: Calcium, calcineurin and the control of transcription. J Biol Chem 2001, 276:2313–2316.

    Article  PubMed  CAS  Google Scholar 

  20. Crabtree GR, Olson EN: NFAT signaling. Choreographing the social lives of cells. Cell 2002, 109:S67–S79.

    Article  PubMed  CAS  Google Scholar 

  21. Lawrence MC, Bhatt HS, Watterson JM, Easom RA: Regulation of insulin gene transcription by a Ca(2+)-responsive pathway involving calcineurin and nuclear factor of activated T cells. Mol Endocrinol 2001, 10:1758–1767.

    Article  Google Scholar 

  22. Tamura K, Fujimura T, Tsutsumi T, et al.: Transcriptional inhibition of insulin by FK506 and possible involvement of FK506 binding protein-12 in pancreatic beta-cell. Transplantation 1995, 59:1606–1613.

    PubMed  CAS  Google Scholar 

  23. Valantine H, Rickenbaker P, Kemna M, et al.: Metabolic abnormalities characteristic of dysmetabolic syndrome predict the development of transplant coronary artery disease. Circulation 2001, 103:2144–2152.

    PubMed  CAS  Google Scholar 

  24. Davidson J, Wilkinson A, Dantal J, et al.; International Expert Panel: New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an International Expert Panel meeting. Barcelona, Spain, 19 February 2003. Transplantation 2003, 75(Suppl 10):S3–S24.

    Google Scholar 

  25. Luan FL, Steffick DE, Gadegbeku C, et al.: Graft and patient survival in kidney transplant recipients selected for de novo steroid-free maintenance immunosuppression. Am J Transplant 2009, 9:160–168.

    Article  PubMed  CAS  Google Scholar 

  26. Shah A, Kendall G, Demme RA, et al.: Home glucometer monitoring markedly improves diagnosis of post renal transplant diabetes mellitus in renal transplant recipients. Transplantation 2005, 80:775–781.

    Article  PubMed  Google Scholar 

  27. Ghisdal L, Bouchta NB, Broeders N, et al.: Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature. Transpl Int 2008, 21:146–151.

    PubMed  CAS  Google Scholar 

  28. Sharif A, Moore R, Baboolal K: Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia. Transplantation 2008, 85:353–358.

    Article  PubMed  Google Scholar 

  29. Kurian B, Joshi R, Helmuth A: Effectiveness and longterm safety of thiazolidinediones and metformin in renal transplant recipients. Endocrinol Pract 2008, 14:979–984.

    Google Scholar 

  30. Pietruck F, Kribben A, Van TN, et al.: Rosiglitazone is a safe and effective treatment option of new-onset diabetes mellitus after renal transplantation. Transpl Int 2005, 18:483–486.

    Article  PubMed  CAS  Google Scholar 

  31. Baldwin D Jr, Duffin KE: Rosiglitazone treatment of diabetes mellitus after solid organ transplantation. Transplantation 2004, 77:1009–1014.

    Article  PubMed  CAS  Google Scholar 

  32. Villaneuva G, Baldwin D: Rosiglitazone therapy of posttransplant diabetes mellitus. Transplantation 2005, 80:1402–1405.

    Article  Google Scholar 

  33. Voytovich MH, Simonsen C, Jenssen T, et al.: Short-term treatment with rosiglitazone improves glucose tolerance, insulin sensitivity and endothelial function in renal transplant recipients. Nephrol Dial Transplant 2005, 20:413–418.

    Article  PubMed  CAS  Google Scholar 

  34. Türk T, Pietruck F, Dolff S, et al.: Repaglinide in the management of new-onset diabetes mellitus after renal transplantation. Am J Transplant 2006, 6:842–846.

    Article  PubMed  Google Scholar 

  35. Nathan DM, Buse JB, Davidson MB, et al.: Management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care 2006, 29:1963–1972.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Siena, Policlinico “Le Scotte”, 3° Lotto — 5S, Viale Bracci 18, 53100, Siena, Italy

    Francesco Dotta

Authors
  1. Vittoria Bonato
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dorica Cataldo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Dotta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mario Carmellini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francesco Dotta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bonato, V., Cataldo, D., Dotta, F. et al. Diagnosis and approach to posttransplant diabetes. Curr Diab Rep 9, 317–323 (2009). https://doi.org/10.1007/s11892-009-0049-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-009-0049-y

Keywords

Search

Navigation