Renal transplantation in diabetic patients: considerations in choosing an immunosuppressive regimen

Diabetic nephropathy is one of the leading causes of end-stage renal disease. Because of this, a significant proportion of patients requiring renal transplantation also have diabetes. Combination renal and pancreas transplant has been shown to be beneficial in some patients with insulin-dependent (type I) diabetes mellitus, but this finding is not consistent in all studies. Strict glycaemic control in the post-transplant patient has been shown to reduce expansion of the mesangial matrix in the glomeruli and, when considered in the context of the Diabetes Control and Complications Trial, strongly suggests that reasonable glycaemic control in the post-transplant patient will improve outcome. A myriad of post-transplant regimens are used; however, almost all regimens will present problems that are of concern in the patient with diabetes. Lastly, post-transplant glycaemic control must be individualised based on the patient's particular characteristics.