Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, 90-549 Lodz, Poland.
Department of Neurosurgery, Surgery of Spine and Peripheral Nerves, Medical University of Lodz, 90-549 Lodz, Poland.
Int J Mol Sci. 2021 Mar 26;22(7):3422. doi: 10.3390/ijms22073422.
End-stage kidney disease (ESKD) is a main public health problem, the prevalence of which is continuously increasing worldwide. Due to adverse effects of renal replacement therapies, kidney transplantation seems to be the optimal form of therapy with significantly improved survival, quality of life and diminished overall costs compared with dialysis. However, post-transplant patients frequently suffer from post-transplant diabetes mellitus (PTDM) which an important risk factor for cardiovascular and cardiovascular-related deaths after transplantation. The management of post-transplant diabetes resembles that of diabetes in the general population as it is based on strict glycemic control as well as screening and treatment of common complications. Lifestyle interventions accompanied by the tailoring of immunosuppressive regimen may be of key importance to mitigate PTDM-associated complications in kidney transplant patients. More transplant-specific approach can include the exchange of tacrolimus with an alternative immunosuppressant (cyclosporine or mammalian target of rapamycin (mTOR) inhibitor), the decrease or cessation of corticosteroid therapy and caution in the prescribing of diuretics since they are independently connected with post-transplant diabetes. Early identification of high-risk patients for cardiovascular diseases enables timely introduction of appropriate therapeutic strategy and results in higher survival rates for patients with a transplanted kidney.
终末期肾病（ESKD）是一个主要的公共卫生问题，其患病率在全球范围内持续上升。由于肾替代治疗的不良反应，与透析相比，肾移植似乎是一种更优的治疗形式，可显著提高生存率、生活质量，并降低总体成本。然而，移植后患者经常患有移植后糖尿病（PTDM），这是移植后心血管和心血管相关死亡的一个重要危险因素。移植后糖尿病的管理类似于普通人群中的糖尿病，其基础是严格的血糖控制以及常见并发症的筛查和治疗。生活方式干预以及免疫抑制方案的调整可能对减轻肾移植患者的 PTDM 相关并发症至关重要。更具移植特异性的方法包括用替代免疫抑制剂（环孢素或雷帕霉素（mTOR）抑制剂）替换他克莫司、减少或停止皮质类固醇治疗以及谨慎使用利尿剂，因为它们与移植后糖尿病独立相关。早期识别心血管疾病高危患者可及时引入适当的治疗策略，从而提高移植肾患者的生存率。
