POST-TRANSPLANT CARE DIABETES TREATMENT

Diabetes mellitus (PTDM) is a common adverse reaction to solid organ transplantation. Using various diagnostic criteria, PTDM has been linked to higher mortality and infections in various transplant groups. Increased glucose monitoring throughout all hospitalizations revealed that the majority of transplant recipients had significant glucose intolerance immediately after the transplant. As a result, the international consensus panel reconsidered its previous recommendations and advised deferring PTDM screening and diagnosis until the recipient is on stable immunosuppression doses after discharge from the initial transplant hospitalisation. While many have adopted hemoglobin A1C as a diagnostic criterion, the group cautioned that it is not reliable as the sole diabetes screening method during the first year after transplant. Many immunosuppressive medications, as well as diabetes medications, are risk factors for PTDM. The provider who manages diabetes, dyslipidemia, and hypertension after transplant must be aware of the increased risk of drug-drug interactions and infections associated with immunosuppressive medications. The increased risk of fluctuating and reduced kidney function, which can lead to hypoglycemia, must be considered in treatment objectives and therapies. While research is being conducted to develop PTDM prevention strategies, it is critical that immunosuppression regimens be chosen based on their evidence to prolong graft survival rather than avoid PTDM.

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