New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines
An endocrinologist’s view
- Jaime A Davidson, MD1,
- Alan Wilkinson, MD2 and
- on behalf of the International Expert Panel on New-Onset Diabetes after Transplantation*
- 1Endocrine and Diabetes Associates of Texas, Dallas, Texas
- 2David Geffen School of Medicine at UCLA, Los Angeles, California
- Address correspondence and reprint requests to Professor J.A. Davidson, Endocrine and Diabetes Associates of Texas, 7777 Forest Ln. B-445, Dallas, TX 75230. E-mail: jdavidson{at}medicalcitydallas.com
- ACE, American College of Endocrinology
- CNI, calcineurin inhibitor
- CVD, cardiovascular disease
- FPG, fasting plasma glucose
- IDF, International Diabetes Federation
- IGT, impaired glucose tolerance
- OGTT, oral glucose tolerance test
New-onset diabetes and impaired glucose tolerance (IGT) are among the most serious metabolic complications of solid organ transplantation. Despite the importance of these conditions to the outcome of transplant recipients, their precise incidence is difficult to determine. This is due to the fact that there has been, until recently, no consensus regarding the definition of new-onset diabetes after transplantation. Thus different studies described in the literature have used a variety of diagnostic criteria (1). Consequently, the reported incidence of new-onset diabetes after transplantation has varied between 2 and 53%, whereas the prevalence of diabetes in the general population is estimated at ∼4% (2,3).
Although new-onset diabetes has been recognized as a complication of transplantation for 50 years (4), the significance of the condition has been grossly underestimated. This is largely due to the fact that diabetes in transplant recipients was generally thought not to be associated with the micro- and macrovascular complications of diabetes in the nontransplant population (5). It is now clear, however, that the development of new-onset diabetes after transplantation is a major determinant of the increased cardiovascular morbidity and mortality seen in transplant recipients (6–8). Furthermore, studies indicate that the development of diabetes after transplantation has serious consequences for the patient, being associated with reduced graft function and patient survival and increased risk of graft loss (5,9,10). In addition, a recent analysis has revealed that the costs of developing new-onset diabetes after kidney transplantation are $12,000–$13,000 higher than for those with no diabetes by the end of the first year following transplantation. These costs rise to $19,000–$22,000 higher by the end of the second year (11).
Studies suggest that a number of risk factors exist that may predict the development of new-onset diabetes in transplant patients. In …
