[Post-transplant diabetes mellitus: diagnosis and treatment]

Post-transplant diabetes mellitus (PTDM) is a type 2 diabetes that has been described in a high percentage of transplanted patients. This complication has a peak incidence in the first few months after transplantation and increases progressively with the length of observation. PTDM is an independent factor for increased cardiovascular risk among solid-organ transplant recipients. New-onset diabetes after transplantation causes a reduction of patient and graft survival. Factors predisposing to the development of diabetes are Afro-American or Hispanic ethnicity, age above 40 years at transplantation, a cadaver kidney donor, HLA, a positive family history, impaired glucose metabolism, HCV positivity, obesity, autosomal polycystic kidney disease, and immunosuppressive therapy. Immunosuppressive therapy is a strong factor for the development of PTDM with a relative risk of 1.557, 3.060 and 5.568 for rapamycin-, cyclosporine- and tacrolimus-based immunosuppression, respectively. The attention of the transplant physician should focus mainly on preventive measures and intervention directed at modifiable risk factors. Of great importance among the latter is an adequate choice of immunosuppressive regimen, particularly in high-risk patients.