New-onset posttransplant diabetes mellitus begins in the dialysis period

New-onset posttransplant diabetes mellitus (PTDM) affects >20% of transplant recipients at 1 year and is associated with increased risk of mortality. From the pathogenetic point of view, PTDM can be considered as the consequence of predisposing factors existing in the dialysis period, which are triggered by immunosuppressive drugs, calcineurin inhibitors, mTOR inhibitors, and steroids.

In our own study, the independent predictors of PTDM were recipient age, a positive family history of diabetes, and treatment by peritoneal dialysis. Other clinical investigations have added the presence of metabolic syndrome components and hepatitis C infection to this list.

Estimation of the risk of development of PTDM should be an integral element in the qualification process for the waiting list. An intensive lifestyle modification program should be offered to candidates with impaired glucose tolerance.