Natural history and epidemiology of post transplantation diabetes mellitus

High patient mortality continues to be the major threat to the success of solid organ transplantation despite improvements in the control of immunologic phenomena post-transplantation with improvements in grafts survival. Post-transplantation diabetes mellitus (PTD) occurring commonly in patients receiving immunosuppressives has been identified as a major culprit.

This paper reviews the current concepts of PTD.

A Medline literature search limited to research /review articles in English language, spanning 1984 January - 2004 June on post transplantation diabetes mellitus or hyperglycemia was done.

Post-transplantation diabetes mellitus is a heterogeneous condition of abnormal glucose tolerance with a variable onset, duration and severity. It is defined as a fasting plasma glucose = 7.0 mmol / L (126 mg / dL) and / or a 2 hour plasma glucose during an OGTT = 11.1 mmol / L (200 mg / dL), or a casual plasma glucose = 11.1 mmol / L (200 mg / dL), on 3 or more occasions over a period of at least 3 months. The risk factors predisposing to PTD are age, recipient's ethnicity, immunosuppressive regimen and family history of diabetes. The condition not only increases the risk of graft-related complications such as graft rejection, graft loss and infection, but also is a major determinant of the increased cardiovascular morbidity and mortality.

The most important risk factor predisposing to the development of PTD is the immunosuppressive drugs. The selection of immunosuppressive regimen should take into account individuals diabetes risk profile and the relative diabetogenicity and risk for diabetes of each immunosuppressant, balancing minimal risk of diabetes with effective immunosuppression.