Clinical impact of posttransplant diabetes mellitus

Published studies of PTDM have reported follow-up periods that are short relative to the evolution of the complications of diabetes. Nevertheless, small studies suggest that PTDM is associated with increased morbidity, similar to that associated with diabetes in the general population, including diabetic nephropathy, raised blood pressure, dyslipidemia and symptoms of coronary artery disease. PTDM is also associated with a trend toward other morbidities and increased mortality. An increase in the risk of infection has been clearly documented in posttransplant patients with diabetes - with sepsis as a major cause of death in early studies, and a suggestion that death from cardiac disease may be similarly increased. These findings probably contribute to the four- to fivefold increase in mortality in patients with diabetes following transplantation, and probably increase risk in the subset of patients with PTDM. Although newer immunosuppressive agents have decreased the need for steroids, the risk of PTDM has not decreased substantially, contributing to graft loss and increased morbidity. Further studies are necessary to elucidate the impact of PTDM on diabetic complications, including retinopathy, about which nothing is known. Long-term studies are also needed, especially follow-up once patients return to dialysis and discontinue immunosuppression, to elucidate whether patients are truly 'posttransplant' diabetics, or whether they represent type 2 diabetics with an accelerated course. In addition, new approaches to immusuppression and development of screening tests for identification of patients at risk for PTDM may allow us to minimize its occurrence and decrease the number of complications with which it is associated. Copyright © 2001 Elsevier Science Inc.