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Post-Transplantation Diabetes Mellitus in Pediatric Patients
Jody B Grundman1, Joseph I Wolfsdorf2, Brynn E Marks1,3
1Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
Insights
Pediatric solid organ transplant recipients can develop post-transplantation diabetes mellitus (PTDM), a condition requiring careful management. Understanding PTDM
Area of Science:
- Pediatric Endocrinology
- Transplant Medicine
- Metabolic Disorders
Background:
- Over 80% of pediatric solid organ transplant (SOT) recipients survive to adulthood.
- Transplant recipients face complications, including post-transplantation diabetes mellitus (PTDM).
- PTDM incidence varies (3-20%) based on transplant type, age, immunosuppression, and history.
Purpose of the Study:
- To review the diagnosis and management of PTDM in pediatric SOT recipients.
- To highlight challenges in applying standard diabetes criteria to this population.
- To emphasize the importance of considering comorbidities and immunosuppressive drug interactions.
Main Methods:
- Literature review on PTDM diagnosis and management in pediatric SOT.
- Analysis of diagnostic criteria and treatment strategies.
- Discussion of clinical considerations for managing PTDM.
Main Results:
- PTDM diagnosis requires persistent hyperglycemia post-transplant on stable immunosuppression.
- Standard American Diabetes Association (ADA) criteria have limitations in pediatric SOT patients.
- PTDM management aligns with type 2 diabetes (T2D) but requires attention to unique patient factors.
Conclusions:
- Clinicians must be aware of PTDM diagnostic challenges in pediatric SOT.
- Effective PTDM management necessitates understanding drug interactions and comorbidities.
- Close collaboration with transplant teams is crucial for optimizing patient outcomes.
Abstract:
More than 80% of pediatric solid organ transplant (SOT) recipients now survive into young adulthood and many encounter transplant-related complications. Post-transplantation diabetes mellitus (PTDM), sometimes also referred to as post-transplant diabetes or new onset diabetes after transplant, occurs in 3-20% of pediatric SOT recipients depending upon the organ transplanted, age at transplantation, immunosuppressive regimen, family history, and time elapsed since transplant. To diagnose PTDM, hyperglycemia must persist beyond the initial hospitalization for transplantation when a patient is on stable doses of immunosuppressive medications. Though standard diagnostic criteria used by the American Diabetes Association (ADA) to diagnose diabetes are employed, clinicians need to be aware of the limitations of using these criteria in this unique patient population. Management of PTDM parallels strategies used for type 2 diabetes (T2D), while also carefully considering comorbidities and potential interactions with immunosuppressive medications in these patients. In caring for patients with PTDM, it is important to be familiar with these interactions and comorbidities in order to coordinate care with the transplant team and optimize outcomes for these patients.
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