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New Onset Diabetes After Liver Transplant

New-onset Diabetes After Liver Transplantation And Its Impact On Complications And Patient Survival.

New-onset Diabetes After Liver Transplantation And Its Impact On Complications And Patient Survival.

New-onset diabetes after liver transplantation and its impact on complications and patient survival. Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China. Department of Endocrinology and Metabolism, Hainan Provincial Nong Ken Hospital, Hainan, China. Department of Liver Surgery, Zhongshan Hospital, Shanghai, China. Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China. J Diabetes. 2015 Nov;7(6):881-90. doi: 10.1111/1753-0407.12275. Epub 2015 Mar 24. BACKGROUND: The aim of the present study was to investigate the incidence and risk factors of new-onset diabetes after transplantation (NODAT) in liver transplant recipients and the influence of NODAT on complications and long-term patient survival. METHODS: We examined 438 patients who underwent liver transplantation between April 2001 and December 2008 and were not diabetic before transplantation. RESULTS: The mean ( SD) follow-up duration was 2.46 1.62 years. The incidence of NODAT 3, 6, 9, 12, 36, and 60 months after transplantation was 44.24%, 25.59%, 23.08%, 25.17%, 17.86%, and 18.18%, respectively. Multifactor analysis indicated that preoperative fasting plasma glucose (FPG) levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an interleukin-2 receptor (IL-2R) antagonist reduced the risk of NODAT. Compared with the no NODAT group (N-NODAT), the NODAT group had a higher rate of sepsis and chronic renal insufficiency. Mean survival was significantly longer in the N-NODAT than NODAT group. Cox regression analysis showed that pre- and/or postoperative FPG levels, tumor recurrence or metastasis, and renal insufficiency after liver transplantation were independent risk factors of mortality. Pulmonary infection Continue reading >>

Prevalence And Risk Factors Of New Onset Diabetes After Liver Transplantation (nodat): A Single Egyptian Center Experience

Prevalence And Risk Factors Of New Onset Diabetes After Liver Transplantation (nodat): A Single Egyptian Center Experience

Original Article - Archives of Digestive Disorders (2017) Volume 1, Issue 1 Prevalence and risk factors of new onset diabetes after liver transplantation (NODAT): A single Egyptian center experience Reham Adly Zayed 1 , Monir Hussein Bahgat 1 * , Mohammed Abdel Wahab 2 1 Department of Hepatology and Gastroenterology, Specialized Medical Hospital, Faculty of Medicine, MansouraUniversity, Mansoura, 35516, Egypt 2 Gastroenterology Surgery and Liver Transplantation Unit, Gastrointestinal Surgery Center, Mansoura University,Mansoura, 35516, Egypt 3 Internal Medicine Department and Liver Transplantation Unit, Gastrointestinal Surgery Center, Mansoura University,Mansoura 35516, Egypt Division of Hepatology and Gastroenterology Specialized Medical Hospital, Mansoura University Citation: Zayed RA, Bahgat MH, Wahab MA, et al. Prevalence and risk factors of new onset diabetes after liver transplantation (NODAT): Asingle Egyptian center experience. Arch Dig Disord. 2017;1(1):7-13 Visit for more related articles at Archives of Digestive Disorders Aim: To estimate the prevalence of New Onset Diabetes after Liver Transplantation (NODAT) and to investigate the possible risk factors. Methods: This retrospective study comprises 213 patients subjected to living donor liver transplantation (LDLT). Patients data were collected from medical registry files for a period of two years after transplant. Results: Of the total 213 recipients, complete data for the whole study period were available for 164 recipients who were enrolled in this study. Fifty one 51 (31.1%) patients were already diabetic prior to transplantation. The prevalence of NODAT was 27.43% (31/113). Eight of NODAT cases (25.8%) were transient with recovery within 6-months period in 5/8 cases while the other 3 cases recovered in Continue reading >>

Post-transplant Diabetes Mellitus: Causes, Treatment, And Impact On Outcomes

Post-transplant Diabetes Mellitus: Causes, Treatment, And Impact On Outcomes

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198 VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105 Search for other works by this author on: Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198 Search for other works by this author on: Division of Diabetes, Endocrinology, and Metabolism (V.S., B.B., J.L.), Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska 68198 Address all correspondence and requests for reprints to: Jennifer Larsen, MD, 987878 Nebraska Medical Center, Omaha, NE 68198-7878. Search for other works by this author on: Endocrine Reviews, Volume 37, Issue 1, 1 February 2016, Pages 3761, Vijay Shivaswamy, Brian Boerner, Jennifer Larsen; Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes, Endocrine Reviews, Volume 37, Issue 1, 1 February 2016, Pages 3761, Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. PTDM has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. An international consensus panel recommended a consistent set of guidelines in 2003 based on American Diabetes Association glucose criteria but did not exclude the immediate post-transplant hospitalization when many patients receive large doses of corticosteroids. Greater glucose monitoring during all hospitalizations has revealed significant glucose intolerance in the majority of reci Continue reading >>

Pretransplant Fasting Glucose Predicts New-onset Diabetes Afterliver Transplantation

Pretransplant Fasting Glucose Predicts New-onset Diabetes Afterliver Transplantation

Pretransplant Fasting Glucose Predicts New-Onset Diabetes afterLiver Transplantation 1Division of Hepatology, Mayo Clinic Arizona, 5777 E. Mayo Boulevard, Phoenix, AZ 85054, USA 2Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, USA 3Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA Received 16 August 2011; Revised 5 October 2011; Accepted 17 October 2011 Copyright 2012 Elizabeth J. Carey et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. New-onset diabetes after transplantation (NODAT) is common after liver transplant and associated with poorer outcomes. The aim of this study was to identify risk factors for NODAT in liver transplant recipients off corticosteroids. In 225 adult nondiabetic liver transplant recipients, the mean age was 51.7 years, the majority were men (71%), and half had HCV (49%). The mean calculated MELD score at transplantation was 18.7, and 19% underwent living-donor transplant (LDLT). One year after transplantation, 17% developed NODAT, and an additional 16% had impaired fasting glucose. The incidence of NODAT in patients with HCV was 26%. In multivariate analysis, HCV, pretransplant FPG, and LDLT were significant. Each 10 mg/dL increase in pretransplant FPG was associated with a twofold increase in future development of NODAT. The incidence of NODAT after liver transplant in patients off corticosteroids is 17%. Risk factors for developing NODAT include HCV and pretransplant FPG; LDLT is protective. Liver transplant recipients are at risk of a number of metabolic complications including new-onset diabetes mellitus, hypertension, hyperlipi Continue reading >>

The Origin Of New-onset Diabetes After Liver Transplantation: Liver, Islets, Or Gut?

The Origin Of New-onset Diabetes After Liver Transplantation: Liver, Islets, Or Gut?

New-onset diabetes is a frequent complication after solid organ transplantation. Using the American Diabetes Association/World Health Organization criteria, 1 the recently estimated incidence is 14% to 44%, 31% to 36%, 32% to 40%, and 28% to 40%, in liver, 2-4 kidney, 5,6 lung, 7,8 and heart transplantations, 9,10 respectively. New-onset diabetes after transplantation is associated with elevated risk of cardiovascular disease and mortality, which impacts the quality of life posttransplantation and increases financial burden. 4,7,11 The pathogenesis and pathophysiology of new-onset diabetes after transplantation has not been fully elucidated yet. Although some factors are commonly associated with new-onset diabetes after most types of solid organ transplantation, such as recipient age, body mass index, hepatitis C infection, and use of immunosuppressive drugs, new-onset diabetes after liver transplantation (NODALT) has unique aspects, thus needs to be considered as its own entity. In this review, we discussed both evidence and speculation regarding the origin of NODALT, and proposed 3 possible origins for NODALT: liver, islets, and gut ( Figure 1 ). Further studies are needed to determine which is the major contributor to facilitate individual clinical care during posttransplant management. The liver is the largest solid organ and performs a wide range of functions, including digestion, detoxification, and immunity. It plays a central role in metabolism, including amino acid synthesis, gluconeogenesis, glycogenolysis, glycogenesis, lipogenesis, and hormone insulin extraction. In liver transplant recipient, the graft becomes the principal organ for carbohydrate, protein, lipid, and drug metabolism, and is responsible for the maintenance of glucose homeostasis. Stockmann Continue reading >>

New Onset Diabetes After Transplantation [nodat] Risks Factors Outcome And Possible Role Of Diabetes Educators

New Onset Diabetes After Transplantation [nodat] Risks Factors Outcome And Possible Role Of Diabetes Educators

Received October 21, 2013; Accepted February 18, 2014; Published February 25, 2014 Citation: Gheith OA, Farouk N, Al-Otaibi T, Saied T (2014) New Onset Diabetes after Transplantation [NODAT] Risks Factors Outcome and Possible Role of Diabetes Educators. J Nephrol Ther S1:S1-005. doi: 10.4172/2161-0959.S1-005 Copyright: 2014 Gheith OA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. New-onset diabetes after transplantation [NODAT] is well known complication after organ transplantation especially after solid organ transplantation, bone marrow and hematopoietic stem cells. The incidence of NODAT was observed to be different over post-transplant intervals. It has many risk factors and adverse clinical outcomes include allograft dysfunction, infections, cardiovascular morbidities, and increased mortalities among renal transplant patients. Its management should start before transplantation with special stress on risk factors, modulation of immunosuppressive agents and role of diabetes education before during and after transplantation. Diabetes education; Renal transplant ; NODAT Patients with operative stress are likely to be associated with acute hyperglycemia. After one month of transplantation, most of patients recover from transplant wound especially in the absence of delayed graft function, rejection, or surgical complications. Nearly 50% of transplant patients with new onset diabetes after transplantation [NODAT] showed improvement in glucose tolerance after reduction of dosage of the immunosuppressive agents. Complete remission from NODAT is difficult to predict, however some Continue reading >>

Hyperglycaemia Within 14 Days Of Liver Transplantation Predicts New Onset Diabetes After Transplantation (nodat) | Gut

Hyperglycaemia Within 14 Days Of Liver Transplantation Predicts New Onset Diabetes After Transplantation (nodat) | Gut

HYPERGLYCAEMIA WITHIN 14 DAYS OF LIVER TRANSPLANTATION PREDICTS NEW ONSET DIABETES AFTER TRANSPLANTATION (NODAT) HYPERGLYCAEMIA WITHIN 14 DAYS OF LIVER TRANSPLANTATION PREDICTS NEW ONSET DIABETES AFTER TRANSPLANTATION (NODAT) Institute of Liver Studies, King's College Hospital, London, UK Introduction New onset diabetes after transplantation (NODAT) is an important complication of liver transplantation associated with greater graft rejection, sepsis, renal impairment, and biliary complications. The aetiology of NODAT is unknown but recognized risk factors include calcineurin inhibitor immunosuppression and hepatitis C infection. There is limited evidence that hyperglycaemia within 14 days post-transplant may also contribute to NODAT. Aims/Background We sought to assess the risk factors associated with NODAT in liver transplant recipients at a major European transplant unit. Method We retrospectively studied 148 consecutive liver transplant recipients in 2009 at King's College Hospital. We gathered demographic and biochemical data, pre-transplant UKELD and MELD scores, aetiology of liver disease, daily glucose kinetics, total daily insulin requirement in the 14 days post-transplant, requirement for diabetes medications at 1 year, immunosuppression therapy (including steroids), intensive care and total hospital stay. Variables were analysed for their ability to predict NODAT using Fisher's exact test (categorical variables), unpaired t test (continuous variables), and logistical regression. Results Of the 148 patients identified, 58 had complete blood glucose data and were included in the analysis. 11/58 had pre-transplant diabetes; 7/58 developed NODAT and 40 did not. Key results are shown in table 1 . Of note, hyperglycaemia in the 14 days post-transplant was associate Continue reading >>

The Origin Of New-onset Diabetes After Liver Transplantation: Liver, Islets, Or Gut?

The Origin Of New-onset Diabetes After Liver Transplantation: Liver, Islets, Or Gut?

The Origin of New-Onset Diabetes After Liver Transplantation: Liver, Islets, or Gut? New-onset diabetes is a frequent complication after solid organ transplantation. Although a number of common factors are associated with the disease, including recipient age, body mass index, hepatitis C infection, and use of immunosuppressive drugs, new-onset diabetes after liver transplantation (NODALT) has the following unique aspects and thus needs to be considered its own entity. First, a liver graft becomes the patient's primary metabolic regulator after liver transplantation, but this would not be the case for kidney or other grafts. The metabolic states, as well as the genetics of the graft, play crucial roles in the development of NODALT. Second, dysfunction of the islets of Langerhans is common in cirrhotic patients and would be exacerbated by immunosuppressive agents, particularly calcineurin inhibitors. On the other hand, minimized immunosuppressive protocols have been widely advocated in liver transplantation because of liver tolerance (immune privilege). Third and last, through the "gut-liver axis," graft function is closely linked to gut microbiota, which is now considered an important metabolic organ and known to independently influence the host's metabolic homeostasis. Liver transplant recipients present with specific gut microbiota that may be prone to trigger metabolic disorders. In this review, we proposed 3 possible sites for the origin of NODALT, which are liver, islets, and gut, to help elucidate the underlying mechanism of NODALT. 2018 Digital Science & Research Solutions, Inc. All Rights Reserved | About us Privacy policy Legal terms VPAT Citation Count is the number of times that this paper has been cited by other published papers in the database. The Altmetri Continue reading >>

New Onset Diabetes After Transplantation (nodat): An Overview

New Onset Diabetes After Transplantation (nodat): An Overview

New onset diabetes after transplantation (NODAT): an overview Phuong-Thu T Pham ,1 Phuong-Mai T Pham ,2,3 Son V Pham ,4 Phuong-Anh T Pham ,5 and 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; 2David Geffen School of Medicine at UCLA, Los Angeles, CA; 6Department of Medicine, Nephrology Division, UCLA Olive View Medical Center, Los Angeles, CA, USA 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 Correspondence: Phuong-Thu T Pham, Associate Clinical Professor of Medicine, Director of Outpatient Services, David Geffen School of Medicine at UCLA, Kidney Transplant Program, Los Angeles, CA 90095, USA, Tel +1 310 794 1757, Email [email protected] Copyright 2011 Pham et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Although renal transplantation ameliorates cardiovascular risk factors by restoring renal function, it introduces new cardiovascular risks including impaired glucose tolerance or diabetes melli Continue reading >>

Elevated Tacrolimus Trough Concentrations Significantly Increase The Risk Of New Onset Diabetes After Liver Transplantation

Elevated Tacrolimus Trough Concentrations Significantly Increase The Risk Of New Onset Diabetes After Liver Transplantation

Elevated Tacrolimus Trough Concentrations Significantly Increase the Risk of New Onset Diabetes after Liver Transplantation R. Amarnath, D. Taber, N. Pilch, H. Meadows, J. Fleming, A. Mardis, K. Morbitzer, C. Jordan, C. Makowski, C. Bratton, J. McGillicuddy, P. Baliga, K. Chavin Transplant Surgery, Medical University of South Carolina, Charleston, SC Analytic Morphomics May Identify Risk Factors for New Onset Diabetes After Kidney Transplantation Background: Tacrolimus (FK) is the most common CNI used following liver transplantation (LTx). FK is highly effective at preventing rejection, but is associated with numerous severe toxicities, particularly new onset diabetes (NODAT). The aim of this study was to determine whether FK trough concentrations affect the incidence of NODAT and other outcomes following LTx. Methods: This was a retrospective analysis of patients who received tacrolimus as part of their immunosuppression regimen following LTx at our center from 2004 to 2011. Pediatric recipients, recipients of multi-organ transplants, and those with graft loss within the first year were excluded. For this analysis patients were grouped by whether their average tacrolimus trough concentration was greater than or less than 6 ng/mL. Results: Baseline characteristics and clinical outcomes for the 310 included patients are shown in Table 1. At baseline, patients in the FK 6 ng/mL group were younger, had better renal function, and were less likely to have a diagnosis of NASH or receive induction or MMF. At last follow-up, the patients with average FK 6 ng/mL had a significantly higher incidence of NODAT, and a trend towards higher rates of HCV recurrence. At end of follow-up, there were no significant differences in acute rejection, graft loss, mortality or renal function. Continue reading >>

Association Between Adipoq Gene Polymorphisms And The Risk Of New-onset Diabetes Mellitus After Liver Transplantation - Sciencedirect

Association Between Adipoq Gene Polymorphisms And The Risk Of New-onset Diabetes Mellitus After Liver Transplantation - Sciencedirect

Association between ADIPOQ gene polymorphisms and the risk of new-onset diabetes mellitus after liver transplantation Get rights and content New-onset diabetes after transplantation (NODAT) has become one of the major factors that affect the overall survival and long-term life quality in liver transplantation (LT) recipients. Previous studies found that the serum adiponectin concentration of diabetic patients is significantly lower than that of healthy subjects. Adiponectin regulates the blood glucose level by increasing body sensitivity to insulin through various mechanisms. In this study, we aimed to investigate the impact of diabetes related gene polymorphisms on the development of NODAT in liver recipients. A total of 256 LT patients in a single-center were selected retrospectively for the study. Genomic DNA was extracted from explanted liver tissues, and tested for twelve diabetes mellitus associated single nucleotide polymorphisms by Sequenom MassARRAY. Modified clinical models in predicting NODAT were established and evaluated. The GG genotype of ADIPOQ rs1501299 gene polymorphism was significantly more frequent in NODAT than non-NODAT LT patients (56% vs 39%, P=0.014). Dominant model (GG vs GT+TT, P=0.030) and recessive model (GT+GG vs TT, P=0.005) also confirmed the genotype distribution difference between NODAT and non-NODAT groups. Age (OR=1.048, P=0.004), BMI (OR=1.107, P=0.041), and blood tacrolimus level at 1-month LT (OR=1.170, P=0.003) were clinical independent risk factors of NODAT. Furthermore, rs1501299 could improve the ability of clinical model in predicting NODAT (AUROC=0.743, P<0.001). ADIPOQ rs1501299 gene polymorphism is associated with an increased risk of NODAT, which should be added to the clinical models in predicting the occurrence of NODA Continue reading >>

Impact Of Immunosuppressant Therapy On New-onset Diabetes In Liver Transplant Recipients

Impact Of Immunosuppressant Therapy On New-onset Diabetes In Liver Transplant Recipients

Editor who approved publication: Professor Deyun Wang Fu-Chao Liu,1,2,* Huan-Tang Lin,1,2,* Jr-Rung Lin,13 Huang-Ping Yu1,2 1Department of Anesthesiology, ChangGung Memorial Hospital, 2College of Medicine, 3Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan *These authors contributed equally tothis work Abstract: This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications beforeprescribing immunosuppressan Continue reading >>

Risk Factors For New Onset Diabetes Mellitus After Liver Transplantation: A Meta-analysis

Risk Factors For New Onset Diabetes Mellitus After Liver Transplantation: A Meta-analysis

Risk factors for new onset diabetes mellitus after liver transplantation: A meta-analysis Number of Hits and Downloads for This Article May 28, 2015 (publication date) through Apr 24, 2018 Baishideng Publishing Group Inc, 7901 Stoneridge Drive, Suite 501, Pleasanton, CA 94588, USA Copyright The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved. World J Gastroenterol.May 28, 2015;21(20): 6329-6340 Published online May 28, 2015.doi: 10.3748/wjg.v21.i20.6329 Risk factors for new onset diabetes mellitus after liver transplantation: A meta-analysis Da-Wei Li, Tian-Fei Lu, Xiang-Wei Hua, Hui-Juan Dai, Xiao-Lan Cui, Jian-Jian Zhang, Qiang Xia Da-Wei Li, Tian-Fei Lu, Xiang-Wei Hua, Hui-Juan Dai, Xiao-Lan Cui, Jian-Jian Zhang, Qiang Xia, Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China Author contributions: Li DW, Lu TF and Hua XW contributed equally to this work; Xia Q and Li DW proposed the study; Li DW, Lu TF and Hua XW performed the literature search and carried out statistical analyses; Dai HJ, Cui XL and Zhang JJ performed data extraction; Hua XW analyzed the data; Li DW and Lu TF wrote the first draft; all authors contributed to the design and interpretation of the study and to further drafts; Xia Q is the guarantor and all authors read and approved the final manuscript. Supported by New Hundred Talents Program of Shanghai Municipal Health and Family Planning Commission, No. XBR2011029. Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which pe Continue reading >>

New-onset Diabetes After Transplantation: Risk Factors And Clinical Impact - Em|consulte

New-onset Diabetes After Transplantation: Risk Factors And Clinical Impact - Em|consulte

Received:5February2010; accepted:21September2010 New-onset diabetes after transplantation: Risk factors and clinical impact Diabte de novo post-greffe: facteurs de risque et consquences cliniques aDepartment of Medicine, hpital Saint-Luc, centre de recherche, centre hospitalier, University of Montreal, 264, Ren-Lvesque-Est, Montral, Qubec, Canada bDepartment of Kinanthropology, universit du Qubec, Montreal, Quebec H3C 3P8, Canada cInstitut universitaire de griatrie, Montreal, Canada Corresponding author. Tel.: +514 890 800034821; fax: +514 412 7377. With improvements in patient and graft survival, increasing attention has been placed on complications that contribute to long-term patient morbidity and mortality. New-onset diabetes after transplantation (NODAT) is a common complication of solid-organ transplantation, and is a strong predictor of graft failure and cardiovascular mortality in the transplant population. Risk factors for NODAT in transplant recipients are similar to those in non-transplant patients, but transplant-specific risk factors such as hepatitis C (HCV) infection, corticosteroids and calcineurin inhibitors play a dominant role in NODAT pathogenesis. Management of NODAT is similar to type 2 diabetes management in the general population. However, adjusting the immunosuppressant regimen to improve glucose tolerance must be weighed against the risk of allograft rejection. Lifestyle modification is currently the strategy with the least risk and the most benefit. The full text of this article is available in PDF format. Grce lamlioration des survies des patients et des greffons, les complications post-greffe, qui contribuent la mortalit et la morbidit des patients long terme suscitent un intrt croissant. Le diabte post-greffe est une complication frquente Continue reading >>

Approach To The Patient With New-onset Diabetes After Transplant (nodat)

Approach To The Patient With New-onset Diabetes After Transplant (nodat)

The Journal of Clinical Endocrinology & Metabolism Approach to the Patient with New-Onset Diabetes after Transplant (NODAT) Division of Endocrinology and Diabetes (J.T.L.), Department of Medicine, and the Harold Hamm Oklahoma Diabetes Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73104 Search for other works by this author on: and Division of Endocrinology, Diabetes and Metabolism (S.D.-J.), University of Tennessee Health Science Center, Memphis, Tennessee 38163 Address all correspondence and requests for reprints to: Samuel Dagogo-Jack, M.D., 920 Madison Avenue, Suite 300A, Memphis, Tennessee 38163. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 11, 1 November 2011, Pages 32893297, James T. Lane, Samuel Dagogo-Jack; Approach to the Patient with New-Onset Diabetes after Transplant (NODAT), The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 11, 1 November 2011, Pages 32893297, New-onset diabetes after transplantation (NODAT) refers to the occurrence of diabetes in previously nondiabetic persons after organ transplantation. The incidence rates of NODAT vary by organ transplanted and posttransplant interval. The estimated rates at 12 months posttransplant are 2050% for kidney transplants, 921% for liver transplants, and approximately 20% for lung transplants. NODAT is associated with increased risks of graft rejection, infection, cardiovascular disease, and death. Besides the traditional risk factors for type 2 diabetes (age, family history, obesity, and ethnicity), exposure to immunosuppressive agents often precedes the occurrence of NODAT. Identification of risk factors through pretransplant screening is desirable, as is prompt diagnosis and appropriate tre Continue reading >>

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