Diabetes after Kidney Transplantation

Abstract

Abnormal glucose metabolism is one of the most important complication encountered after renal transplantation. Besides the well-known type 2 diabetes mellitus, there are other two abnormal conditions that must be mentioned, high fasting plasma glucose and impaired glucose tolerance. The last one is often misdiagnosed because it needs an oral glucose tolerance (OGT), rarely used in clinical practice. The 15-30% of patients on waiting list of renal transplantation have impaired glucose tolerance. Therefore OGT should be performed in non-diabetic patients and when glycosylated hemoglobin is > 5.8 %. At 1 year after renal transplantation, about 15% of patients develops de novo diabetes, 28% after 3 years. Besides traditional risk factors, a primary role is played by immunosuppressive drugs because they reduce both the synthesis and peripheral activity of insulin. Hence the therapy of diabetes after renal transplantation must look at the cautious management of immunosuppressive therapy, in particular of the drugs like corticosteroids and tacrolimus. In most cases, either reducing or weaning these drugs can help us to achieve an improving of glucose metabolism.