Post transplant Diabetes Mellitus

Abstract

The increasing amount of solid organs transplantation as a therapeutic alternative in different diseases is accompanied by an increase in the prevalence of post transplantation diabetes mellitus.
Despite last years improvement of graft and patient overlife after solid organ transplantation, the receivers continue showing an important prevalence of cardiovascular disease in comparison with the general population. The factors which determine this condition are the hypertension, hyperlipidemia, and diabetes mellitus. Among them, the post- transplantation diabetes mellitus has been identified like one of the most important factors that in addition to the increase of cardiovascular mortality, also reduces the graft function, increases the risks of infections and the percentage of graft loss.
There exist several risk factors associated to this disease. Among the potentially modifiable factors is the presence of metabolic syndrome and obesity before the transplantation, while amid the non- modifiable ones we find the antecedent of diabetes mellitus type 2 in relatives of first degree, the age of over 40 years and the hepatitis C virus infection. The predisposition to develop this pathology is related to the type of inmunosuppression received. The corticosteroids and calcineurin inhibitors (cyclosporine and tacrolimus) are drugs with a great diabetogenic capacity.
In 2003 the International Consensus Guidelines were published on New Onset Diabetes After Transplantation, declaring that the diagnosis is performed according to the criteria of the American Association of Diabetes. It was also stated the use of the algorithm of treatment for diabetes mellitus type 2 which should be done considering the possible interactions with inmunosuppressors drugs and their eventual adverse effects. In spite of this, most of the patients with DMPT require treatment with insulin.
We must remember that the best therapeutic option is prevention, that is why it is fundamental to identify the risk factors, to treat those that are potentially reversible before the transplantation and to adapt the inmunosuppressor treatment with the intention of diminishing the risk of developing this disease.