The Journal of Heart and Lung Transplantation
New-onset diabetes after transplantation
Section snippets
Incidence of new-onset diabetes after transplantation
The precise incidence of new-onset diabetes after transplantation has been difficult to determine due to the lack, until recently, of a consensus regarding the definition of the condition. Furthermore, the incidence of the condition in many studies is underestimated, because the observation periods are too short (<1 year). Indeed, the risk of developing new-onset diabetes has been shown to increase progressively post-transplant, and patients may still develop the condition up to 15 years after
Risk factors for the development of new-onset diabetes after transplantation
There are no well-established risk factors for new-onset diabetes after heart transplantation; however, a number of characteristics have been identified for kidney and liver transplant patients that appear to predispose individuals to the development of the condition (Table 1). 17, 18, 19, 20 In particular, there is good evidence that patients with a family history of diabetes among first-degree relatives and those of Hispanic or African American ethnicity have a greater risk of developing
Impact of new-onset diabetes after transplantation
The precise impact of new-onset diabetes on the outcome of heart transplant patients is difficult to assess as few studies have described the condition in this population. Some reports have shown that patients with diabetes at the time of heart transplantation have a poorer outcome than those without the condition.6, 7, 43 In particular, heart transplant patients with diabetes have an increased risk of serious infection; within 3 months post-transplant, the infection rate among patients with
Guidelines for the management of new-onset diabetes after transplantation
It is now recognized that the prevention of new-onset diabetes after transplantation, and early detection and appropriate treatment of patients who develop diabetes, are key considerations for the management of transplant recipients and can ameliorate the long-term consequences of the condition. Until recently, precise guidance on the management of transplant recipients at risk of developing diabetes was lacking. However, in 2003, International Consensus Guidelines (ICG) on new-onset diabetes
Conclusions
New-onset diabetes after transplantation is a serious complication of organ transplantation. Its cumulative incidence in heart transplant recipients may reach 32% at 5 years, similar to that reported in kidney and liver transplant patients. Despite the paucity of data reporting the impact of new-onset diabetes after transplantation in heart transplant patients, it would appear reasonable that early detection and appropriate treatment may have an impact on transplant outcomes in this population.
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