Diabetes and kidney transplantation: past, present, and future.

Diabetes mellitus is the most common etiology for end stage renal disease (ESRD) worldwide and in the United States. The incidence of morbidity and mortality is higher in diabetic patients with ESRD due to increased cardiovascular events. Patients with type 2 diabetes who receive a renal allograft have a higher survival rate compared with patients who are maintained on chronic hemodialysis therapy, but there is scarcity of data on long-term graft outcomes. Most recently the development of new onset diabetes after transplantation (NODAT) poses a serious threat to patient and allograft survival. Pre-emptive transplantation and the use of living donors have improved overall survival. In addition, critical management of glucose, blood pressure, and cholesterol are some of the factors that can help minimize adverse outcomes in both patients with pre-existing diabetes and patients who develop NODAT. Future clinical trials are warranted to improve therapeutic medical management of these patients thus influencing graft attrition.