Wyzgał J, Paczek L, Sańko-Resmer J, Ciszek M, Nowak M, Rowiński W, Szmidt J, Durlik M
Department of Immunology, Transplantation Institute, Transplant Medicine and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
Ann Transplant. 2007;12(2):26-9.
Post-transplant diabetes mellitus (PTDM) is one of the main complications observed in patients after organ transplantation. The incidence of PTDM in transplant recipients is about 9 times higher than in general population. The reported incidence of PTDM varied throughout the years due to different diagnostic criteria of diabetes mellitus. Nowadays the rate of PTDM amounts to 3-19%.
MATERIALS/METHODS: 1270 patients after kidney transplantation, who remained under medical care in the outpatient service at the Transplantation Institute in Warsaw, were taken into consideration. The investigated group comprised 207 patients. 133 of them developed DM that constitutes the incidence of PTDM at 10.5%.
In the present study several risk factors that are important for PTDM development were observed: male gender, HLA A3, family history of DM, increased body weight (rather than BMI only), tacrolimus--based immunosuppressive regimen, early hyperglycemia. Patients with PTDM developed hypertension more frequently, had higher serum triglycerides levels in the period before the onset of diabetes. The rate of acute rejection episodes in this group was higher compared with the nondiabetic transplant controls. The PTDM group presented with worse graft function and higher levels of proteinuria in 1-year observation. Tacrolimus--based therapy led to higher peripheral insulin resistance and hyperinsulinemia in comparison to cyclosporine--based regimen.
The proper management of the above described risk factors and the right treatment of PTDM may considerably influence life expectancy rate and quality of life in transplanted patients.
移植后糖尿病（PTDM）是器官移植患者中观察到的主要并发症之一。移植受者中PTDM的发病率比普通人群高约9倍。由于糖尿病的诊断标准不同，多年来报道的PTDM发病率有所变化。如今，PTDM的发生率为3%-19%。
材料/方法：考虑了在华沙移植研究所门诊接受医疗护理的1270例肾移植患者。研究组包括207例患者。其中133例发生糖尿病，PTDM发病率为10.5%。
在本研究中，观察到几个对PTDM发生很重要的危险因素：男性、HLA A3、糖尿病家族史、体重增加（而非仅BMI）、基于他克莫司的免疫抑制方案、早期高血糖。PTDM患者更频繁地发生高血压，在糖尿病发病前血清甘油三酯水平更高。与非糖尿病移植对照组相比，该组急性排斥反应的发生率更高。在1年的观察中，PTDM组的移植肾功能更差，蛋白尿水平更高。与基于环孢素的方案相比，基于他克莫司的治疗导致更高的外周胰岛素抵抗和高胰岛素血症。
对上述危险因素进行适当管理以及对PTDM进行正确治疗可能会显著影响移植患者的预期寿命和生活质量。
