Diabetic Kidney Disease in Post-Transplant Diabetes Mellitus: Causes, Treatment and Outcomes

Kidney transplant recipients are a unique subgroup of chronic kidney disease patients due to their single functioning kidney, immunosuppressive agent usage, and long-term complications related to transplantation. Post-transplant diabetes mellitus (PTDM) has a significant adverse effect on renal outcomes in particular. As transplantations enable people to live longer, cardiovascular morbidity and mortality become more prevalent, and PTDM is a key risk factor for these complications. Although PTDM results from similar risk factors to those of type 2 diabetes, the conditions differ in their pathophysiology and clinical features. Transplantation itself is a risk factor for diabetes due to chronic exposure to immunosuppressive agents. Considering current evidence, this article describes the risk factors, pathogenesis, diagnostic criteria, prevention strategies, and management of PTDM. The therapeutic options are discussed regarding their safety and potential drug-drug interactions with immunosuppressive agents.

Automated summary

Kidney transplant recipients have unique characteristics due to their single functioning kidney, immunosuppressive agent usage, and long-term complications related to transplantation. Post-transplant diabetes mellitus (PTDM) has a significant impact on renal outcomes. PTDM is a key risk factor for cardiovascular morbidity and mortality in transplant recipients, and its pathophysiology and clinical features differ from type 2 diabetes. Transplantation itself, with chronic exposure to immunosuppressive agents, is a risk factor for PTDM. This article discusses the risk factors, pathogenesis, diagnostic criteria, prevention strategies, and management of PTDM, as well as the safety and potential drug-drug interactions of therapeutic options with immunosuppressive agents.