Bodziak Kenneth A, Hricik Donald E
Department of Medicine, Division of Nephrology and Hypertension, Case Western Reserve University and the Transplantation Service, University Hospitals Case Medical Center, Cleveland, OH 44106, USA.
Transpl Int. 2009 May;22(5):519-30. doi: 10.1111/j.1432-2277.2008.00800.x. Epub 2008 Nov 20.
New-onset diabetes mellitus is a common complication of solid organ transplantation and is likely to become even more common with the current epidemic of obesity in some countries. It has become clear that both new-onset diabetes and prediabetic states (impaired fasting glucose and impaired glucose tolerance) negatively influence graft and patient survival after transplantation. This observation forms the basis for recommending meticulous screening for glucose intolerance before and after transplantation. Although a number of clinical factors including age, weight, ethnicity, family history, and infection with hepatitis C are closely associated with the new-onset diabetes mellitus, immunosuppression with corticosteroids, calcineurin inhibitors and possibly sirolimus plays a dominant role in its pathogenesis. Management of new-onset diabetes after transplantation generally conforms to the guidelines for treatment of type 2 diabetes mellitus in the general population. However, further studies are needed to determine the optimal immunosuppressive regimens for patients with this disorder.
新发糖尿病是实体器官移植常见的并发症，在一些国家，随着当前肥胖流行趋势，其可能会变得更加常见。现已明确，新发糖尿病和糖尿病前期状态（空腹血糖受损和糖耐量受损）均会对移植后的移植物和患者存活产生负面影响。这一观察结果为推荐在移植前后对葡萄糖不耐受进行细致筛查奠定了基础。尽管包括年龄、体重、种族、家族史以及丙型肝炎感染在内的诸多临床因素与新发糖尿病密切相关，但使用皮质类固醇、钙调神经磷酸酶抑制剂以及可能还有西罗莫司进行免疫抑制在其发病机制中起主要作用。移植后新发糖尿病的管理通常遵循普通人群2型糖尿病的治疗指南。然而，仍需进一步研究以确定针对该疾病患者的最佳免疫抑制方案。
