Posttransplantation Diabetes

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Posttransplantation diabetes (PTDM) is, as the name implies, the development of diabetes after transplantation. Steroid diabetes was first reported in renal-transplant recipients (38). Its early frequency was 40 percent to 60 percent (38). The incidence ranges from 2 percent to 50 percent, with most cases being diagnosed within three months of transplantation (39, 40). Risk factors for posttransplant diabetes include age, non-Caucasian ethnicity (risk of posttransplantation diabetes is higher in African

American recipients than Caucasian recipients), and immunosuppression (39). Transplant recipients with posttransplant diabetes tend to be 0 to 12 years older than those without (39). Non-Caucasian patients had a twofold increased risk of post-transplant diabetes (RR 3.3, 95 percent CI 1.7-7.0) (39). There is an increased incidence of posttransplant diabetes in patients treated with glucocorticoid therapy, cyclosporine, and those treated with high doses of tacrolimus (39, 41). The mean time from transplantation to development of PTDM is 1.2 years (range from one day to 6.2 years), with most cases occurring during the first three months after transplant or after treatment for rejection (41, 42). Significant risk-factor development of PTDM included: first-degree family history of type 2 diabetes mellitus, tacrolimus use, and hyperglycemia in the two weeks immediately after transplantation (42). Patients that developed persistent PTDM had later onset disease (mean 1.9 years) compared to those with transient PTDM (0.3 years) (42).

Posttransplantation diabetes is associated with impaired long-term allograft survival and function. Reported six-year actuarial graft survival in one series was 67 percent in patients with PTDM versus 93 percent in control patients (38). Another series reported a 12-year graft survival of 48 percent for patients with PTDM versus 70 percent in control patients (38, 40).

Cirrhosis is commonly associated with impaired glucose metabolism. Sixty to 80 percent of people with cirrhosis develop mild glucose intolerance associated with hyperinsulinism and increased insulin resistance (43). Diabetes mellitus develops in 10 percent to 30 percent of people with cirrhosis (43). Liver transplantation does not significantly modify pretransplant diabetes (43). Diabetes after liver transplant frequently develops de novo, is transient, and seems to be related primarily to immunosuppressive drug administration (43).

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