Published online Apr 15, 2015. doi: 10.4239/wjd.v6.i3.445
Peer-review started: August 25, 2014
First decision: October 14, 2014
Revised: November 14, 2014
Accepted: January 9, 2015
Article in press: January 9, 2015
Published online: April 15, 2015
Processing time: 238 Days and 2.3 Hours
A diagnosis of new-onset diabetes after transplantation (NODAT) carries with it a threat to the renal allograft, as well as the same short- and long-term implications of type 2 diabetes seen in the general population. NODAT usually occurs early after transplantation, and is usually diagnosed according to general population guidelines. Non-modifiable risk factors for NODAT include advancing age, African American, Hispanic, or South Asian ethnicity, genetic background, a positive family history for diabetes mellitus, polycystic kidney disease, and previously diagnosed glucose intolerance. Modifiable risk factors for NODAT include obesity and the metabolic syndrome, hepatitis C virus and cytomegalovirus infection, corticosteroids, calcineurin inhibitor drugs (especially tacrolimus), and sirolimus. NODAT affects graft and patient survival, and increases the incidence of post-transplant cardiovascular disease. The incidence and impact of NODAT can be minimized through pre- and post-transplant screening to identify patients at higher risk, including by oral glucose tolerance tests, as well as multi-disciplinary care, lifestyle modification, and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin. Since NODAT is a major cause of post-transplant morbidity and mortality, measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.
Core tip: New-onset diabetes after kidney transplantation (NODAT) is detrimental to patient and graft survival. Early diagnosis through the identification of modifiable and non-modifiable risk factors for NODAT and appropriate screening, accompanied by good glycemic control that involves a multidisciplinary care approach will help result in good short- and long-term kidney transplant outcomes.