Abstract：
OBJECTIVE: Kidney transplantation is the gold standard therapeutic alternative for patients with end-stage renal disease; nevertheless, it is not without potential complications leading to considerable morbidity and mortality such as post-transplant diabetes mellitus (PTDM). This narrative review aims to comprehensively evaluate PTDM in terms of its diagnostic approach, underlying pathophysiological pathways, epidemiological data, and management strategies.
METHODS: Articles were retrieved from electronic databases using predefined search terms. Inclusion criteria encompassed studies investigating PTDM diagnosis, pathophysiology, epidemiology, and management strategies.
RESULTS: PTDM emerges as a significant complication following kidney transplantation, influenced by various pathophysiological factors including peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways. Despite discrepancies in prevalence estimates, PTDM poses substantial challenges to transplant. Diagnostic approaches, including traditional criteria such as fasting plasma glucose (FPG) and HbA1c, are limited in their ability to capture early PTDM manifestations. Oral glucose tolerance test (OGTT) emerges as a valuable tool, particularly in the early post-transplant period. Management strategies for PTDM remain unclear, within sufficient evidence from large-scale randomized clinical trials to guide optimal interventions. Nevertheless, glucose-lowering agents and life style modifications constitute primary modalities for managing hyperglycemia in transplant recipients.
CONCLUSIONS: The complex interplay between PTDM and the transplant process necessitates individualized diagnostic and management approaches. While early recognition and intervention are paramount, modifications to maintenance immunosuppressive regimens based solely on PTDM risk are not warranted, given the potential adverse consequences such as increased rejection risk. Further research is essential to refine management strategies and enhance outcomes for transplant recipients.
METHODS: Articles were retrieved from electronic databases using predefined search terms. Inclusion criteria encompassed studies investigating PTDM diagnosis, pathophysiology, epidemiology, and management strategies.
RESULTS: PTDM emerges as a significant complication following kidney transplantation, influenced by various pathophysiological factors including peripheral insulin resistance, immunosuppressive medications, infections, and proinflammatory pathways. Despite discrepancies in prevalence estimates, PTDM poses substantial challenges to transplant. Diagnostic approaches, including traditional criteria such as fasting plasma glucose (FPG) and HbA1c, are limited in their ability to capture early PTDM manifestations. Oral glucose tolerance test (OGTT) emerges as a valuable tool, particularly in the early post-transplant period. Management strategies for PTDM remain unclear, within sufficient evidence from large-scale randomized clinical trials to guide optimal interventions. Nevertheless, glucose-lowering agents and life style modifications constitute primary modalities for managing hyperglycemia in transplant recipients.
CONCLUSIONS: The complex interplay between PTDM and the transplant process necessitates individualized diagnostic and management approaches. While early recognition and intervention are paramount, modifications to maintenance immunosuppressive regimens based solely on PTDM risk are not warranted, given the potential adverse consequences such as increased rejection risk. Further research is essential to refine management strategies and enhance outcomes for transplant recipients.
摘要：
目的：肾移植是治疗终末期肾病的金标准选择，它并非没有导致相当高的发病率和死亡率的潜在并发症,如移植后糖尿病(PTDM).这篇叙述性综述旨在全面评估PTDM的诊断方法，潜在的病理生理途径，流行病学数据，和管理策略。
方法：使用预定义的搜索词从电子数据库中检索文章。纳入标准包括调查PTDM诊断的研究，病理生理学,流行病学,和管理策略。
结果：PTDM是肾移植后的重要并发症，受各种病理生理因素的影响，包括外周胰岛素抵抗，免疫抑制药物,感染,和促炎途径。尽管患病率估计存在差异，PTDM对移植提出了重大挑战。诊断方法，包括传统标准，如空腹血糖（FPG）和HbA1c，它们捕获早期PTDM表现的能力有限。口服葡萄糖耐量试验（OGTT）作为一种有价值的工具，特别是在移植后的早期。PTDM的管理策略尚不清楚，在大规模随机临床试验的足够证据范围内，以指导最佳干预措施。然而，降糖药和生活方式的改变是移植受者治疗高血糖的主要方式.
结论：PTDM和移植过程之间复杂的相互作用需要个性化的诊断和管理方法。虽然早期认识和干预至关重要，不保证仅基于PTDM风险对维持免疫抑制方案进行修改,考虑到潜在的不良后果，如拒绝风险增加。进一步的研究对于完善管理策略和增强移植受体的结果至关重要。
方法：使用预定义的搜索词从电子数据库中检索文章。纳入标准包括调查PTDM诊断的研究，病理生理学,流行病学,和管理策略。
结果：PTDM是肾移植后的重要并发症，受各种病理生理因素的影响，包括外周胰岛素抵抗，免疫抑制药物,感染,和促炎途径。尽管患病率估计存在差异，PTDM对移植提出了重大挑战。诊断方法，包括传统标准，如空腹血糖（FPG）和HbA1c，它们捕获早期PTDM表现的能力有限。口服葡萄糖耐量试验（OGTT）作为一种有价值的工具，特别是在移植后的早期。PTDM的管理策略尚不清楚，在大规模随机临床试验的足够证据范围内，以指导最佳干预措施。然而，降糖药和生活方式的改变是移植受者治疗高血糖的主要方式.
结论：PTDM和移植过程之间复杂的相互作用需要个性化的诊断和管理方法。虽然早期认识和干预至关重要，不保证仅基于PTDM风险对维持免疫抑制方案进行修改,考虑到潜在的不良后果，如拒绝风险增加。进一步的研究对于完善管理策略和增强移植受体的结果至关重要。
