[Diabetes after Kidney Transplantation].

Area of Science:

• Nephrology
• Endocrinology
• Transplantation Medicine

Background:

• Abnormal glucose metabolism is a significant complication post-renal transplantation.
• Conditions include type 2 diabetes mellitus, high fasting plasma glucose, and impaired glucose tolerance (IGT).
• IGT is often underdiagnosed due to infrequent use of oral glucose tolerance tests (OGT).

Purpose of the Study:

• To highlight the prevalence and diagnostic challenges of abnormal glucose metabolism after renal transplantation.
• To emphasize the importance of OGT in identifying IGT in pre- and post-transplant patients.
• To discuss the role of immunosuppressive drugs in post-transplant diabetes.

Main Methods:

• Review of existing literature on glucose metabolism abnormalities in renal transplant recipients.
• Analysis of diagnostic criteria for diabetes and glucose intolerance.
• Discussion of the impact of immunosuppressive agents on insulin regulation.

Main Results:

• 15-30% of renal transplant candidates have IGT.
• 15% of patients develop de novo diabetes within 1 year post-transplant, rising to 28% by 3 years.
• Immunosuppressive drugs (e.g., corticosteroids, tacrolimus) significantly contribute to insulin resistance and reduced insulin activity.

Conclusions:

• OGT should be considered for non-diabetic patients with glycosylated hemoglobin > 5.8% before transplantation.
• Careful management of immunosuppressive therapy is crucial for managing post-transplant diabetes.
• Reducing or discontinuing certain immunosuppressants can improve glucose metabolism.