Pathogenesis, risk factors and clinical impact of post transplant diabetes mellitus after renal transplantation

Abstract

Post transplant diabetes mellitus (PTDM) is one of the most significant a complications after renal transplantation. PTDM is diabetes mellitus which develops de novo after renal transplantation. Pathophysiology has important similarities to type 2 Diabetes Mellitus in that there is coexisting insulin resistance and insulin hyposecretion. Thus, pathogenesis appears to be multifactorial due to the combination of the background of previously existing opposing factors determined by age, ethnicity, genetic and lifestyle compounded by pre existing chronic kidney disease and the use of immunosuppressive drugs such as corticosteroids and calcineurin inhibitors. PTDM is associated with an increased level of mortality and cardiac disease, an increased risk of infection with sepsis being a major cause of death. Furthermore, hyperglycaemia is associated with an increased risk of allograft rejection, and horse graft function. Survival is associated with a reduced quality of life in transplant recipients. The prevention, possible early diagnosis and effective treatment of PTDM are necessary in the prevention of chronic complications caused by diabetes and to improve the prognosis and quality of patient’s life.