Oslo University Hospital Rikshospitalet, Section of Nephrology, Department of Organ Transplantation, Oslo, Norway.
Expert Opin Pharmacother. 2011 Dec;12(17):2641-55. doi: 10.1517/14656566.2011.628936. Epub 2011 Nov 3.
New-onset diabetes after transplantation (NODAT) is considered to be a major cause of cardiovascular disease and death among patients with a functioning allograft. A major challenge is to reduce the incidence of NODAT and to treat it optimally once it has occurred.
This review presents current data on how to prevent NODAT in patients at risk, with a focus on modifications in the immunosuppressive regimen. Current suggestions for detection and treatment of NODAT are also presented.
Prevention of NODAT is possible by assessing the patient's glycemic risk prior to transplantation and tailoring the treatment (e.g., choice and dosage of immunosuppressive agents) after transplantation. An oral glucose tolerance test is still the gold standard to detect NODAT in patients at risk (prediabetes) but algorithms can be used to select those who should be tested. The treatment of NODAT involves a broad approach on risk factors for cardiovascular events and graft loss. Future studies on the use of oral hypoglycemic agents in NODAT are still needed.
移植后新发糖尿病（NODAT）被认为是移植后功能良好的同种异体移植物患者发生心血管疾病和死亡的主要原因。主要挑战是降低 NODAT 的发生率，并在发生后对其进行最佳治疗。
本文综述了目前关于如何预防高危患者 NODAT 的数据，重点是免疫抑制方案的调整。还提出了目前关于 NODAT 的检测和治疗建议。
通过在移植前评估患者的血糖风险并在移植后调整治疗（例如免疫抑制剂的选择和剂量），可以预防 NODAT。口服葡萄糖耐量试验仍然是检测高危（糖尿病前期）患者 NODAT 的金标准，但可以使用算法来选择需要检测的患者。NODAT 的治疗涉及针对心血管事件和移植物丢失的风险因素的广泛方法。仍需要进一步研究 NODAT 中口服降糖药的使用。
