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Immunosuppression and Post-transplant Hyperglycemia.

Nuria Montero, Julio Pascual1

  • 1Department of Nephrology, Hospital del Mar. Passeig Maritim 25-29, 08010 Barcelona, Spain. julpascual@gmail.com.

Current Diabetes Reviews
|April 1, 2015
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Summary

Post-transplant diabetes mellitus (PTDM) is linked to immunosuppression drugs like corticosteroids and calcineurin inhibitors. Balancing PTDM risk with graft survival is crucial for transplant patients.

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Area of Science:

  • Transplantation immunology
  • Endocrinology
  • Pharmacology

Background:

  • Post-transplant diabetes mellitus (PTDM) is a significant risk factor for cardiovascular disease following solid organ transplantation.
  • The pathophysiology of PTDM involves pancreatic beta-cell dysfunction and insulin resistance, with ongoing debate on their relative contributions.

Purpose of the Study:

  • To review the diabetogenic effects of immunosuppressive agents used in solid organ transplantation.
  • To assess the risk-benefit profile of immunosuppression in the context of PTDM development.

Main Methods:

  • Comprehensive literature search of MEDLINE, EMBASE, and Cochrane Central Register up to January 2015.
  • Inclusion of systematic reviews, meta-analyses, randomized clinical trials, and observational studies when necessary.

Main Results:

  • Corticosteroids, calcineurin inhibitors (tacrolimus, cyclosporine), and mTOR inhibitors (sirolimus, everolimus) exhibit known diabetogenic effects.
  • Limited evidence links induction agents to PTDM; azathioprine and mycophenolate mofetil derivatives show no diabetogenic effects.

Conclusions:

  • Immunosuppression is a major modifiable risk factor for PTDM, necessitating a risk-benefit analysis against graft rejection.
  • Caution is advised when adjusting immunosuppressants if PTDM develops.
  • Prioritize immunosuppression regimens optimizing patient and graft survival, regardless of PTDM risk.