Vol 9, No 5 (2020)
Review article
Published online: 2020-11-10

open access

Page views 1403
Article views/downloads 1051
Get Citation

Connect on Social Media

Connect on Social Media

New Onset Diabetes After Transplantation (NODAT) — scientific data review

Katarzyna Zielińska1, Leszek Kukulski, Marta Wróbel, Piotr Przybyłowski, Marta Zielińska, Krzysztof Strojek
Clin Diabetol 2020;9(5):356-366.


New onset diabetes after transplantation (NODAT) is one of the most common and serious complications of solid organ transplantation. The incidence of NODAT is estimated to range from 2% to 53%. Patients who develop new onset diabetes after transplantation are significantly more frequently exposed to a higher risk of death and cardiovascular incidents as well as other adverse effects, such as decreased patient survival, higher infection rates and early graft loss. Identifying high-risk patients, undertaking preventive action and applying appropriate treatment can limit the development of new onset diabetes after transplantation and improve a patient’s long-term prognosis.

Article available in PDF format

View PDF Download PDF file


  1. Rodrigo E, Fernández-Fresnedo G, Valero R, et al. New-onset diabetes after kidney transplantation: risk factors. J Am Soc Nephrol. 2006; 17(12 Suppl 3): S291–S295.
  2. Milczarek M, Wojciechowska M, Mamcarz A, et al. Waskulopatia w przeszczepionym sercu — nowe trendy w diagnostyce i leczeniu. Folia Cardiologica. 2017; 12(1): 50–54.
  3. Chakkera HA, Weil EJ, Castro J, et al. Hyperglycemia during the immediate period after kidney transplantation. Clin J Am Soc Nephrol. 2009; 4(4): 853–859.
  4. Bergrem HA, Valderhaug TG, Hartmann A, et al. Undiagnosed diabetes in kidney transplant candidates: a case-finding strategy. Clin J Am Soc Nephrol. 2010; 5(4): 616–622.
  5. Sharif A, Hecking M, de Vries APJ, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014; 14(9): 1992–2000.
  6. Hecking M, Werzowa J, Haidinger M, et al. European-New-Onset Diabetes After Transplantation Working Group. Novel views on new-onset diabetes after transplantation: development, prevention and treatment. Nephrol Dial Transplant. 2013; 28(3): 550–566.
  7. Bloom RD, Crutchlow MF. New-onset diabetes mellitus in the kidney recipient: diagnosis and management strategies. Clin J Am Soc Nephrol. 2008; 3 Suppl 2: S38–S48.
  8. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med. 1998; 15(7): 539–553, doi: 10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S.
  9. Araszkiewicz A, Bandurska-Stankiewicz E, Budzyński A, et al. 2019 Guidelines on the management of diabetic patients. A position of Diabetes Poland. Clinical Diabetology. 2019; 8(1): 1–95.
  10. Armstrong KA, Prins JB, Beller EM, et al. Should an oral glucose tolerance test be performed routinely in all renal transplant recipients? Clin J Am Soc Nephrol. 2006; 1(1): 100–108.
  11. Ye X, Kuo HT, Sampaio MS, et al. Risk factors for development of new-onset diabetes mellitus after transplant in adult lung transplant recipients. Clin Transplant. 2011; 25(6): 885–891.
  12. Montori VM, Basu A, Erwin PJ, et al. Posttransplantation diabetes: a systematic review of the literature. Diabetes Care. 2002; 25(3): 583–592.
  13. Hjelmesaeth J, Midtvedt K, Jenssen T, et al. Insulin resistance after renal transplantation: impact of immunosuppressive and antihypertensive therapy. Diabetes Care. 2001; 24(12): 2121–2126.
  14. Sharif A, Cohney S. Post-transplantation diabetes—state of the art. The Lancet Diabetes & Endocrinology. 2016; 4(4): 337–349.
  15. Hjelmesaeth J, Asberg A, Müller F, et al. New-onset posttransplantation diabetes mellitus: insulin resistance or insulinopenia? Impact of immunosuppressive drugs, cytomegalovirus and hepatitis C virus infection. Curr Diabetes Rev. 2005; 1(1): 1–10.
  16. Pham PTT, Pham PMT, Pham SV, et al. New onset diabetes after transplantation (NODAT): an overview. Diabetes Metab Syndr Obes. 2011; 4: 175–186.
  17. Ye X, Kuo HT, Sampaio MS, et al. Risk factors for development of new-onset diabetes mellitus in adult heart transplant recipients. Transplantation. 2010; 89(12): 1526–1532.
  18. Kasiske BL, Snyder JJ, Gilbertson D, et al. Diabetes mellitus after kidney transplantation in the United States. Am J Transplant. 2003; 3(2): 178–185.
  19. Dedinská I, Graňák K, Vnučák M, et al. Role of sex in post-transplant diabetes mellitus development: Are men and women equal? J Diabetes Complications. 2019; 33(4): 315–322.
  20. Sumrani NB, Delaney V, Ding ZK, et al. Diabetes mellitus after renal transplantation in the cyclosporine era--an analysis of risk factors. Transplantation. 1991; 51(2): 343–347.
  21. Martínez-Castelao A, Hernández MD, Pascual J, et al. investigators of the HIGLU study. Detection and treatment of post kidney transplant hyperglycemia: a Spanish multicenter cross-sectional study. Transplant Proc. 2005; 37(9): 3813–3816.
  22. Baid S, Cosimi AB, Farrell ML, et al. Posttransplant diabetes mellitus in liver transplant recipients: risk factors, temporal relationship with hepatitis C virus allograft hepatitis, and impact on mortality. Transplantation. 2001; 72(6): 1066–1072.
  23. Hjelmesaeth J, Sagedal S, Hartmann A, et al. Asymptomatic cytomegalovirus infection is associated with increased risk of new-onset diabetes mellitus and impaired insulin release after renal transplantation. Diabetologia. 2004; 47(9): 1550–1556.
  24. Hjelmesaeth J, Müller F, Jenssen T, et al. Is there a link between cytomegalovirus infection and new-onset posttransplantation diabetes mellitus? Potential mechanisms of virus induced beta-cell damage. Nephrol Dial Transplant. 2005; 20(11): 2311–2315.
  25. Schweer T, Gwinner W, Scheffner I, et al. High impact of rejection therapy on the incidence of post-transplant diabetes mellitus after kidney transplantation. Clin Transplant. 2014; 28(4): 512–519.
  26. Numakura K, Satoh S, Tsuchiya N, et al. Clinical and genetic risk factors for posttransplant diabetes mellitus in adult renal transplant recipients treated with tacrolimus. Transplantation. 2005; 80(10): 1419–1424.
  27. Gourishankar S, Jhangri GS, Tonelli M, et al. Development of diabetes mellitus following kidney transplantation: a Canadian experience. Am J Transplant. 2004; 4(11): 1876–1882.
  28. Yates CJ, Barraclough KA, McWhinney BC, et al. A practical limited sampling strategy to predict free prednisolone exposure and glycemia in kidney transplant recipients. Ther Drug Monit. 2014; 36(1): 18–23.
  29. Cieniawski D, Miarka P, Jaśkowski P, et al. Cukrzyca potransplantacyjna — trudności w diagnostyce i rozpoznaniu. Varia Medica. 2018; 61873: 446–449.
  30. Alebiosu OC, Ayodele OE. Natural history and epidemiology of post transplantation diabetes mellitus. Afr Health Sci. 2005; 5(3): 255–260.
  31. Vincenti F, Friman S, Scheuermann E, et al. DIRECT (Diabetes Incidence after Renal Transplantation: Neoral C Monitoring Versus Tacrolimus) Investigators. Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus. Am J Transplant. 2007; 7(6): 1506–1514.
  32. Prasad GV, Kim SJ, Huang M, et al. Reduced incidence of new-onset diabetes mellitus after renal transplantation with 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors (statins). Am J Transplant. 2004; 4(11): 1897–1903.
  33. Flechner SM, Glyda M, Cockfield S, et al. The ORION study: comparison of two sirolimus-based regimens versus tacrolimus and mycophenolate mofetil in renal allograft recipients. Am J Transplant. 2011; 11(8): 1633–1644.
  34. Johnston O, Rose CL, Webster AC, et al. Sirolimus is associated with new-onset diabetes in kidney transplant recipients. J Am Soc Nephrol. 2008; 19(7): 1411–1418.
  35. Durlik M, Polskie Towarzystwo Transplantacyjne, Zalecenia dotyczące leczenia immunosupresyjnego po przeszczepieniu narządów unaczynionych, 2014.
  36. Vest LS, Koraishy FM, Zhang Z, et al. Metformin use in the first year after kidney transplant, correlates, and associated outcomes in diabetic transplant recipients: A retrospective analysis of integrated registry and pharmacy claims data. Clin Transplant. 2018; 32(8): e13302.
  37. Palepu S, Prasad GV. New-onset diabetes mellitus after kidney transplantation: Current status and future directions. World J Diabetes. 2015; 6(3): 445–455.
  38. Balas B, Belfort R, Harrison SA, et al. Pioglitazone treatment increases whole body fat but not total body water in patients with non-alcoholic steatohepatitis. J Hepatol. 2007; 47(4): 565–570.
  39. Habib ZA, Havstad SL, Wells K, et al. Thiazolidinedione use and the longitudinal risk of fractures in patients with type 2 diabetes mellitus. J Clin Endocrinol Metab. 2010; 95(2): 592–600.
  40. Kermode-Scott B. Meta-analysis confirms raised risk of bladder cancer from pioglitazone. BMJ. 2012; 345: e4541.
  41. Cehic MG, Nundall N, Greenfield JR, et al. Management Strategies for Posttransplant Diabetes Mellitus after Heart Transplantation: A Review. J Transplant. 2018; 2018: 1025893.
  42. Boerner BP, Miles CD, Shivaswamy V. Efficacy and safety of sitagliptin for the treatment of new-onset diabetes after renal transplantation. Int J Endocrinol. 2014; 2014: 617638.
  43. Amin M, Suksomboon N. Pharmacotherapy of type 2 diabetes mellitus: an update on drug-drug interactions. Drug Saf. 2014; 37(11): 903–919.
  44. Arjona Ferreira JC, Corry D, Mogensen CE, et al. Efficacy and safety of sitagliptin in patients with type 2 diabetes and ESRD receiving dialysis: a 54-week randomized trial. Am J Kidney Dis. 2013; 61(4): 579–587.
  45. Ravassa S, Zudaire A, Díez J. GLP-1 and cardioprotection: from bench to bedside. Cardiovasc Res. 2012; 94(2): 316–323.
  46. Scirica BM, Bhatt DL, Braunwald E, et al. SAVOR-TIMI 53 Steering Committee and Investigators. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013; 369(14): 1317–1326.
  47. White WB, Cannon CP, Heller SR, et al. EXAMINE Investigators. Alogliptin after acute coronary syndrome in patients with type 2 diabetes. N Engl J Med. 2013; 369(14): 1327–1335.
  48. Green JB, Bethel MA, Armstrong PW, et al. TECOS Study Group. Effect of Sitagliptin on Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2015; 373(3): 232–242.
  49. Zinman B, Wanner C, Lachin JM, et al. EMPA-REG OUTCOME Investigators. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015; 373(22): 2117–2128.
  50. Elam M, Lovato L, Ginsberg H. The ACCORD-Lipid study: implications for treatment of dyslipidemia in Type 2 diabetes mellitus. Clin Lipidol. 2011; 6(1): 9–20.