Posttransplant diabetes

New-onset diabetes is a common occurrence after solid organ transplantation. Tests and criteria for diagnosing new-onset diabetes after transplantation are the same as those recommended by the World Health Organization and the American Diabetes Association for the diagnoses of diabetes in other settings. Several risk factors have been identified, including race/ethnicity, family history, overweight/ obesity and many immunosuppressants (e.g. steroids, calcineurin inhibitors and mTOR inhibitors). In transplant recipients, the onset of diabetes has a negative effect on patient and graft survival, through the increase in metabolic and cardiovascular comorbidities, infections and acceleration of the onset and progression of chronic complications of diabetes. Dietary and exercise counseling and tailoring of immunosuppression are important to prevent diabetes after solid organ transplantation. Periodic screening for diabetes after transplantation is recommended for all transplant recipients, and management of hyperglycemia should be intensive and started right after diagnosis. Treatment choices include insulin, metformin, meglitinide derivatives and dipeptidyl peptidase 4 inhibitors, with special attention to renal function and risk of hypoglycemia.