Diabetes in Kidney Transplant Recipients

Abstract

Preexisting diabetes is common in kidney transplant recipients as it is a leading cause of end-stage renal disease. Hyperglycemia is present in nearly 90% of kidney transplant recipients in immediate postoperative period but it is not sustained in the majority. In addition to the general risk factors for diabetes, certain transplantation related variables (e.g. specific immunosuppressive agents, surgical stress and inflammation, nutritional interventions) place this patient population at elevated risk for hyperglycemia. Preexisting diabetes and posttransplantation diabetes confer reduced patient and graft survival in kidney transplant recipients. Robust evidence base guiding precise glycemic goals is lacking in kidney transplant recipients. Management is largely guided by evidence from general diabetes population. Hospital management of hyperglycemia is primarily achieved through insulin regimen that takes into account rapid changes in glucocorticoid doses, nutritional modalities, renal function, during immediate posttransplantation period. There is an opportunity to use oral or non-insulin injectable agents in a considerable number of patients by the time of discharge from the hospital or in the long run. Use of specific oral or non-insulin injectable agent is guided by patient specifics and pharmacologic properties of medications. A comprehensive approach to addressing additional risk factors and comorbidities is required to reduce the micro- and macro-vascular complications from diabetes.