New onset diabetes after transplantation (NODAT): an overview

Phuong-Thu T Pham¹, Phuong-Mai T Pham^2,3, Son V Pham⁴, Phuong-Anh T Pham⁵, Phuong-Chi T Pham^2,6
1Nephrology Division, Kidney Transplant Program, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA; ²David Geffen School of Medicine at UCLA, Los Angeles, CA; ³Department of Medicine, Greater Los Angeles VA Medical Center, Los Angeles, CA; ⁴Division of Cardiology, Bay Pines VA Medical Center, Bay Pines, FL; ⁵Division of Cardiology, Memphis VA Medical Center, Memphis, TN; ⁶Department of Medicine, Nephrology Division, UCLA Olive View Medical Center, Los Angeles, CA, USA

Abstract: Although renal transplantation ameliorates cardiovascular risk factors by restoring renal function, it introduces new cardiovascular risks including impaired glucose tolerance or diabetes mellitus, hypertension, and dyslipidemia that are derived, in part, from immunosuppressive medications such as calcineurin inhibitors, corticosteroids, or mammalian target of rapamycin inhibitors. New onset diabetes mellitus after transplantation (NODAT) is a serious and common complication following solid organ transplantation. NODAT has been reported to occur in 2% to 53% of all solid organ transplants. Kidney transplant recipients who develop NODAT have variably been reported to be at increased risk of fatal and nonfatal cardiovascular events and other adverse outcomes including infection, reduced patient survival, graft rejection, and accelerated graft loss compared with those who do not develop diabetes. Identification of high-risk patients and implementation of measures to reduce the development of NODAT may improve long-term patient and graft outcome. The following article presents an overview of the literature on the current diagnostic criteria for NODAT, its incidence after solid organ transplantation, suggested risk factors and potential pathogenic mechanisms. The impact of NODAT on patient and allograft outcomes and suggested guidelines for early identification and management of NODAT will also be discussed.

Keywords: new onset diabetes after transplantation (NODAT), cyclosporine, tacrolimus, sirolimus, hepatitis C and diabetes, cytomegalovirus and diabetes