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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2015; 6(3): 445-455
Published online Apr 15, 2015. doi: 10.4239/wjd.v6.i3.445
New-onset diabetes mellitus after kidney transplantation: Current status and future directions
Sneha Palepu, G V Ramesh Prasad
Sneha Palepu, G V Ramesh Prasad, Division of Nephrology, University of Toronto, St. Michael’s Hospital, Toronto ON M5C 2T2, Canada
Author contributions: Palepu S and Prasad GVR contributed to this paper.
Conflict-of-interest: Both authors (Sneha Palepu and G V Ramesh Prasad) have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: G V Ramesh Prasad, MBBS, MSc, MA, FRCPC, FACP, FASN, Associate Professor of Medicine, Division of Nephrology, University of Toronto, St. Michael’s Hospital, 61 Queen Street East, 9th Floor, Toronto ON M5C 2T2, Canada. prasadr@smh.ca
Telephone: +1-416-8673722 Fax: +1-416-8673709
Received: August 25, 2014
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
Abstract

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.

Keywords: Cyclosporine; Graft; Kidney; New-onset diabetes; Tacrolimus; Transplantation

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.