Hyperglycemia and Diabetes Mellitus Following Organ Transplantation

Overview

Journal Curr Diab Rep

Publisher Current Science

Specialty Endocrinology

Date 2016 Jan 25

PMID 26803650

Citations 15

Authors

Rodolfo J Galindo

Amisha Wallia

Affiliations

Soon will be listed here.

Abstract

Hyperglycemia is common following organ transplantation, regardless of the pre-transplant diabetes status. Transient post-transplant hyperglycemia and/or new-onset diabetes after transplantation (NODAT) are common and are associated with increased morbidity and mortality. NODAT and type 2 diabetes share similar characteristics, but the pathophysiology may differ. Immunosuppressive agents and steroids play a key role in the development of NODAT. Glycemic control is challenging in this population due to fluctuating renal/end-organ function, immunosuppressive dosing, nutritional status, and drug-drug interactions. A proactive and multidisciplinary approach is essential, along with flexible protocols to adjust to patient status, type of organ transplanted, and corticosteroid regimens. Insulin is the preferred agent for hospitalized patients and during the early post-transplant period; optimal glycemic control (BG < 180 mg/dl with minimal hypoglycemia [<70 mg/dl]) is desired.

Citing Articles

Risk of Incident Post-Transplantation Diabetes Mellitus After Solid Organ Transplantation in Taiwan: A Population-Based Cohort Study.

Tai C, Huang K, Wang J, Gau S, Huang S, Su K Healthcare (Basel). 2025; 13(5).

PMID: 40077085 PMC: 11898666. DOI: 10.3390/healthcare13050523.

New Onset Diabetes After Organ Transplantation: Risk Factors, Treatment, and Consequences.

Popovic L, Bulum T Diagnostics (Basel). 2025; 15(3).

PMID: 39941214 PMC: 11816453. DOI: 10.3390/diagnostics15030284.

Progress of new-onset diabetes after liver and kidney transplantation.

Zhang Z, Sun J, Guo M, Yuan X Front Endocrinol (Lausanne). 2023; 14:1091843.

PMID: 36843576 PMC: 9944581. DOI: 10.3389/fendo.2023.1091843.

Prevalence and Risk Factors of Abnormal Glucose Metabolism and New-Onset Diabetes Mellitus after Kidney Transplantation: A Single-Center Retrospective Observational Cohort Study.

Alfieri C, Favi E, Campioli E, Cicero E, Molinari P, Campise M Medicina (Kaunas). 2022; 58(11).

PMID: 36363565 PMC: 9694737. DOI: 10.3390/medicina58111608.

Excess Risk of Major Adverse Cardiovascular and Kidney Events after Acute Kidney Injury following Living Donor Liver Transplantation.

Chan Y, Yeh C, Li L, Chen C, Wang C, Lin C J Clin Med. 2022; 11(11).

PMID: 35683487 PMC: 9181469. DOI: 10.3390/jcm11113100.

References

Soleimanpour S, Crutchlow M, Ferrari A, Raum J, Groff D, Rankin M . Calcineurin signaling regulates human islet {beta}-cell survival. J Biol Chem. 2010; 285(51):40050-9. PMC: 3000987. DOI: 10.1074/jbc.M110.154955. View

Moon J, Barbeito R, Faradji R, Gaynor J, Tzakis A . Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: Long-term follow up. Transplantation. 2007; 82(12):1625-8. DOI: 10.1097/01.tp.0000250361.60415.96. View

Yadav A, Chang Y, Aqel B, Byrne T, Chakkera H, Douglas D . New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database. J Transplant. 2013; 2013:269096. PMC: 3800575. DOI: 10.1155/2013/269096. View

Matas A, Gillingham K, Elick B, Dunn D, Gruessner R, Payne W . Risk factors for prolonged hospitalization after kidney transplants. Clin Transplant. 1997; 11(4):259-64. View

Moen M, Zhan M, Hsu V, Walker L, Einhorn L, Seliger S . Frequency of hypoglycemia and its significance in chronic kidney disease. Clin J Am Soc Nephrol. 2009; 4(6):1121-7. PMC: 2689888. DOI: 10.2215/CJN.00800209. View

Umpierrez G, Cardona S, Pasquel F, Jacobs S, Peng L, Unigwe M . Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial. Diabetes Care. 2015; 38(9):1665-72. PMC: 4542267. DOI: 10.2337/dc15-0303. View

Sharif A, Moore R, Baboolal K . Influence of lifestyle modification in renal transplant recipients with postprandial hyperglycemia. Transplantation. 2008; 85(3):353-8. DOI: 10.1097/TP.0b013e3181605ebf. View

Pham P, Pham P, Lipshutz G, Wilkinson A . New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin North Am. 2007; 36(4):873-90. DOI: 10.1016/j.ecl.2007.07.007. View

Shabir S, Jham S, Harper L, Ball S, Borrows R, Sharif A . Validity of glycated haemoglobin to diagnose new onset diabetes after transplantation. Transpl Int. 2013; 26(3):315-21. DOI: 10.1111/tri.12042. View

10.

Hackman K, Bailey M, Snell G, Bach L . Diabetes is a major risk factor for mortality after lung transplantation. Am J Transplant. 2014; 14(2):438-45. DOI: 10.1111/ajt.12561. View

11.

Cosio F, Pesavento T, Kim S, Osei K, Henry M, Ferguson R . Patient survival after renal transplantation: IV. Impact of post-transplant diabetes. Kidney Int. 2002; 62(4):1440-6. DOI: 10.1111/j.1523-1755.2002.kid582.x. View

12.

Lang C, Beniaminovitz A, Edwards N, Mancini D . Morbidity and mortality in diabetic patients following cardiac transplantation. J Heart Lung Transplant. 2003; 22(3):244-9. DOI: 10.1016/s1053-2498(02)00567-3. View

13.

Chakkera H, Weil E, Castro J, Heilman R, Reddy K, Mazur M . Hyperglycemia during the immediate period after kidney transplantation. Clin J Am Soc Nephrol. 2009; 4(4):853-9. PMC: 2666437. DOI: 10.2215/CJN.05471008. View

14.

Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite S, Deutschman C . Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012; 40(12):3251-76. DOI: 10.1097/CCM.0b013e3182653269. View

15.

Alexander J, Metze T, McIntosh M, Goodman H, First M, Munda R . The influence of immunomodulatory diets on transplant success and complications. Transplantation. 2005; 79(4):460-5. DOI: 10.1097/01.tp.0000148802.04879.27. View

16.

Axelrod D, Dzebisashvili N, Lentine K, Segev D, Dickson R, Tuttle-Newhall E . Assessing variation in the costs of care among patients awaiting liver transplantation. Am J Transplant. 2013; 14(1):70-8. DOI: 10.1111/ajt.12494. View

17.

Park C, Hsu C, Neelakanta G, Nourmand H, Braunfeld M, Wray C . Severe intraoperative hyperglycemia is independently associated with surgical site infection after liver transplantation. Transplantation. 2009; 87(7):1031-6. DOI: 10.1097/TP.0b013e31819cc3e6. View

18.

Umpierrez G, Reyes D, Smiley D, Hermayer K, Khan A, Olson D . Hospital discharge algorithm based on admission HbA1c for the management of patients with type 2 diabetes. Diabetes Care. 2014; 37(11):2934-9. PMC: 4207201. DOI: 10.2337/dc14-0479. View

19.

Ollech J, Kramer M, Peled N, Ollech A, Amital A, Medalion B . Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors. Eur J Cardiothorac Surg. 2008; 33(5):844-8. DOI: 10.1016/j.ejcts.2008.01.050. View

20.

van Raalte D, Ouwens D, Diamant M . Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options?. Eur J Clin Invest. 2009; 39(2):81-93. DOI: 10.1111/j.1365-2362.2008.02067.x. View