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Post-transplantation diabetes mellitus.

¹Division of Endocrinology, University of Texas Southwestern Medical School, Dallas, Texas 75390-8857, USA. pablo.mora@utsouthwestern.edu

The American Journal of the Medical Sciences

|February 16, 2005

Summary

Post-transplantation diabetes mellitus (PTDM) is a condition of sustained hyperglycemia after organ transplant. Key risk factors include immunosuppressive drugs like tacrolimus, necessitating new screening and management strategies.

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Area of Science:

Endocrinology
Transplant Medicine
Metabolic Disorders

Background:

Post-transplantation diabetes mellitus (PTDM) is defined as new-onset hyperglycemia post-transplant, meeting diagnostic criteria for diabetes.
Identified risk factors include older age, nonwhite ethnicity, glucocorticoid therapy, and immunosuppressants like cyclosporine and tacrolimus.

Observation:

The pathophysiology mirrors type 2 diabetes, involving pre-existing insulin resistance from end-stage organ disease and exacerbated by post-transplant glucocorticoids.
Calcineurin inhibitors (cyclosporine, tacrolimus) appear to cause a reversible defect in insulin secretion, acting as a 'second hit'.

Findings:

An international consensus conference has proposed updated strategies for PTDM screening, prevention, and management.
These recommendations aim to address the growing challenge of PTDM in transplant recipients.

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Implications:

Future research should focus on glucose load testing for high-risk patients.
Pharmacological interventions targeting insulin resistance and beta-cell preservation are crucial for managing PTDM.