New-onset diabetes after transplantation: a review of recent literature

Purpose of review New-onset diabetes after transplantation (NODAT) is a serious complication of organ transplantation. Data from kidney transplant studies show that NODAT is a strong independent predictor of graft failure and cardiovascular mortality. This article reviews NODAT in context of some of the recent data on definition, incidence, risk factors, genetics, and the impact on graft survival and cardiovascular events. Recent findings The reported incidence of NODAT continues to be high. The variability in the incidence can be attributed to varying definitions used in studies and also to the immunosuppressive regimens used at various centers. A 5-day oral glucose tolerance test may be a better predictor for developing NODAT. Comparison studies of various immunosuppressants in contributing to this condition show variable and conflicting results. Hepatitis C has emerged as a strongly associated risk factor and sirolimus may not be less diabetogenic, as thought before. In addition to serious infections, NODAT has been associated with increased cardiovascular risk and atherosclerosis and higher graft failures. Summary New-onset diabetes continues to be a common and potentially serious complication after organ transplantation. Risk stratification, early diagnosis, and intervention for this condition may contribute to better long-term graft survival and help in reducing cardiovascular mortality.