CMV prophylaxis: a useful step towards prevention of post-transplant diabetes?

Excerpt

Diabetes is a common complication of organ transplantation, with reported frequencies ranging from 3 to 45% of renal transplant recipients. The wide range around this estimate reflects differences between immunosuppressive regimens, differing definitions of post-transplant diabetes, and a failure to correct for the background incidence of diabetes mellitus in the transplant population. We analysed 352 renal transplant recipients who received calcineurin inhibitor (ciclosporin A or tacrolimus) and corticosteroid “double therapy” in our unit. We found that 9% of patients receiving ciclosporin A (12 mg·kg⁻¹·day⁻¹) and 11% of patients receiving tacrolimus (0.2 mg·kg⁻¹·day⁻¹) developed diabetes within 3 months of transplantation, as defined using the ADA criteria for diagnosis of diabetes, and still had diabetes 1 year after transplantation. This rate of approximately 10% is consistent with the published data, and confirms that post-transplant diabetes is a common problem. Diabetes has an impact on transplant outcome in terms of lifestyle restrictions and—although definitive studies are lacking—there are indications that patient and transplant survival are both adversely affected [1, 2]. How then can we minimise the impact of this problem? …