Risk for posttransplant diabetes mellitus with current immunosuppressive medications

With improvements in the practice of transplantation and the introduction o f new immunosuppressive medications, there has been a substantial increase in 1-year allograft survival rates. Consequently, the pool of potential can didates for organ transplants continues to grow and a greater preponderance of older patients with more comorbidities are undergoing transplantation. As a result, there is interest in such medical complications as posttranspl antation diabetes mellitus (PTDM) that develop after the transplantation of a successful allograft. PTDM is an undesirable consequence of transplantat ion because of its associated morbidity and impairment of both patient and graft survival. Although some controversy exists, it is likely that glucose intolerance after transplantation results in both macrovascular and microv ascular disease, and there is an increasing risk for infectious and cardiov ascular diseases, to which transplant recipients are already at increased s usceptibility. Both experimental and clinical observations have shown that immunosuppressive agents currently used in transplantation account for a la rge degree of the increased risk for PTDM. Consequently, improved understan ding of the effects of currently used immunosuppressive medicines on glycem ic tolerance is of interest in clinical transplantation. (C) 1999 by the Na tional Kidney Foundation, Inc.