[Post-transplantational diabetes mellitus]

Newly developed diabetes and impaired glucose tolerance are frequent post-transplantation metabolic complications. In most reports, the incidence of newly-diagnosed diabetes in such patients varies from 10 to 26%. They are at high risk of cardiovascular complications, infections, graft rejection, and impaired survival compared with recipients having normal blood glucose level. Some of the above risk factors are common for the general population (age, excess body weight, familial diabetes, afroamerican ethnicity, arterial hypertension, dyslipidemia). Specific risk factors characteristic of the post-transplantation period include the use of glucocorticoids and imunodepressants (especially tacrolimus and mTOR inhibitors) as well as infections (HCV and possibly cytomegalovirus). Screening for diabetes and evaluation of risk factors are recommended to all patients before and after transplantation. Patients of high-risk groups should be treated using non-diabetogenic protocols of immunosuppression. Achievement of normoglycemia, control of lipid levels and arterial pressure, screening for diabetes complications are indispensable components of the treatment aimed at the improvement of clinical outcome in the patients developing diabetes after organ transplantation.