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Diabetes mellitus and transplantation 

Diabetes mellitus and transplantation
Chapter:
Diabetes mellitus and transplantation
Author(s):

Riley Paul

and John O’Grady

DOI:
10.1093/med/9780199235292.003.1599
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date: 14 December 2019

Diabetes mellitus is a common and significant complication of solid organ transplantation, affecting approximately 20% of transplant recipients (1). However, reported incidences vary widely due to a combination of varying historical definitions, whether diabetes is transient or sustained, and the profile of risk factors, including the immunosuppressive regimens used.

The development of the entity of ‘new-onset diabetes after transplantation’ (NODAT) is gaining attention, as it can be associated with early microvascular complications (2) and an increase in cardiovascular risk (3–5). Cardiovascular disease is the most common cause of post-transplant death in some series (6). NODAT is also associated with an increased risk of infection, graft failure, and patient mortality (1, 3, 4, 7, 8). NODAT and pre-existing diabetes mellitus have also been associated with more aggressive disease recurrence after liver transplantation, particularly of hepatitis C (9).

Because of the above, considerable effort has been focused on identifying and reducing an individual’s risk of NODAT; establishing effective screening to allow early diagnosis and early intervention to prevent or delay the development of severe complications. In addition, the increased flexibility in immunosuppression regimens as a consequence of the wider range of drugs available is allowing the individualization of therapy that may be directed at reducing the risk of NODAT.

The wide ranges quoted for the incidence of NODAT preclude meaningful comparison between the different solid organs. However, liver transplantation is notable because of the very high incidence of transient impairment of glycaemic control immediately after implantation of the graft (resistant hyperglycaemia may be an indicator of poor early function), which is not considered to represent NODAT unless it persists beyond 2 weeks after transplantation. In addition, some people with pre-existing diabetes receiving liver transplants buck the trend and exhibit significant reductions in insulin requirements after liver transplantation, presumably due to increased tissue sensitivity.

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