Langsford David, Steinberg Adam, Dwyer Karen M
Northern Health, 185 Cooper Street, Epping, Melbourne, VIC, 3075, Australia.
University of Melbourne, Melbourne, VIC, Australia.
Drugs Aging. 2017 Aug;34(8):589-601. doi: 10.1007/s40266-017-0478-2.
Post-transplant diabetes mellitus occurs in 30-50% of cases during the first year post-renal transplantation. It is associated with increased morbidity, mortality and healthcare costs. Risk factors include age and specific immunosuppression regimens. At the same time, renal transplantation is increasingly indicated in elderly (aged >65 years) patients as this proportion of older patients in the prevalent dialysis population has increased. The immune system and β cells undergo senescence and this impacts on the risk for developing post-transplant diabetes and our ability to prevent such development. It may, however, be possible to identify patients at risk of developing post-transplant diabetes, enabling treatment protocols that prevent or reduce the impact of post-transplant diabetes. Much work remains to be completed in this area and is facilitated by the growing base of knowledge regarding the pathophysiology of post-transplant diabetes. Should post-transplant diabetes develop, there are a range of treatment options available. There is increasing interest in using newer agents, although their safety and efficacy in transplant recipients remains to be conclusively established.
肾移植后糖尿病在肾移植后的第一年发生于30%至50%的病例中。它与发病率、死亡率及医疗费用增加相关。危险因素包括年龄和特定的免疫抑制方案。与此同时，肾移植在老年（年龄>65岁）患者中越来越多地被采用，因为在透析患者群体中，老年患者的比例有所增加。免疫系统和β细胞会衰老，这会影响肾移植后糖尿病的发病风险以及我们预防其发生的能力。然而，有可能识别出有发生肾移植后糖尿病风险的患者，从而制定预防或减轻肾移植后糖尿病影响的治疗方案。该领域仍有许多工作有待完成，而关于肾移植后糖尿病病理生理学的知识不断积累有助于这项工作。如果发生了肾移植后糖尿病，有一系列治疗选择可供采用。人们对使用新型药物的兴趣日益增加，尽管它们在移植受者中的安全性和有效性仍有待最终确定。
