Palepu Sneha, Prasad G V Ramesh
Sneha Palepu, G V Ramesh Prasad, Division of Nephrology, University of Toronto, St. Michael's Hospital, Toronto ON M5C 2T2, Canada.
World J Diabetes. 2015 Apr 15;6(3):445-55. doi: 10.4239/wjd.v6.i3.445.
A diagnosis of new-onset diabetes after transplantation (NODAT) carries with it a threat to the renal allograft, as well as the same short- and long-term implications of type 2 diabetes seen in the general population. NODAT usually occurs early after transplantation, and is usually diagnosed according to general population guidelines. Non-modifiable risk factors for NODAT include advancing age, African American, Hispanic, or South Asian ethnicity, genetic background, a positive family history for diabetes mellitus, polycystic kidney disease, and previously diagnosed glucose intolerance. Modifiable risk factors for NODAT include obesity and the metabolic syndrome, hepatitis C virus and cytomegalovirus infection, corticosteroids, calcineurin inhibitor drugs (especially tacrolimus), and sirolimus. NODAT affects graft and patient survival, and increases the incidence of post-transplant cardiovascular disease. The incidence and impact of NODAT can be minimized through pre- and post-transplant screening to identify patients at higher risk, including by oral glucose tolerance tests, as well as multi-disciplinary care, lifestyle modification, and the use of modified immunosuppressive regimens coupled with glucose-lowering therapies including oral hypoglycemic agents and insulin. Since NODAT is a major cause of post-transplant morbidity and mortality, measures to reduce its incidence and impact have the potential to greatly improve overall transplant success.
移植后新发糖尿病（NODAT）的诊断不仅对肾移植受者构成威胁，而且具有与普通人群中2型糖尿病相同的短期和长期影响。NODAT通常发生在移植后早期，通常根据普通人群的指南进行诊断。NODAT的不可改变的危险因素包括年龄增长、非裔美国人、西班牙裔或南亚族裔、遗传背景、糖尿病家族史阳性、多囊肾病以及先前诊断的糖耐量异常。NODAT的可改变危险因素包括肥胖和代谢综合征、丙型肝炎病毒和巨细胞病毒感染、皮质类固醇、钙调神经磷酸酶抑制剂药物（尤其是他克莫司）和西罗莫司。NODAT会影响移植物和患者的存活，并增加移植后心血管疾病的发生率。通过移植前和移植后的筛查以识别高危患者，包括口服葡萄糖耐量试验，以及多学科护理、生活方式改变，以及使用改良的免疫抑制方案并结合包括口服降糖药和胰岛素在内的降糖疗法，可以将NODAT的发生率和影响降至最低。由于NODAT是移植后发病和死亡的主要原因，降低其发生率和影响的措施有可能极大地提高整体移植成功率。
