An update review of post-transplant diabetes mellitus: Concept, risk factors, clinical implications and management
This 2024 review synthesizes current evidence on post-transplant diabetes mellitus (PTDM), noting that oral glucose tolerance testing detects early PTDM better than standard fasting glucose or HbA1c, though management strategies still lack strong randomized trial evidence.
Background
Post-transplant diabetes mellitus (PTDM) is a frequent complication after kidney transplantation, driven by peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways, and substantially affects transplant morbidity and mortality.
Key findings
Traditional diagnostic criteria (fasting plasma glucose, HbA1c) often miss early PTDM; the oral glucose tolerance test is more sensitive, particularly in the early post-transplant period. Management remains largely guided by expert opinion rather than large randomized trials.
Clinical implications
The authors caution against modifying maintenance immunosuppression based solely on PTDM risk, since that can increase rejection risk, and instead recommend individualized diagnostic and management strategies combining glucose-lowering therapy and lifestyle changes.
Category
Transplant
Source
Diabetes, Obesity and Metabolism
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