Abstract
Diabetes is the most common cause of renal failure which is frequently seen in candidates of solid organ transplant both before and after of the transplantation. For successful long-term tissue graft, it is important to control blood glucose level particularly after transplantation. Post-transplant diabetes mellitus (PTDM) is the main issue contributing to cardiovascularrelated mortality in kidney transplant recipients. Important risk factors of PTDM include using immunosuppressive drugs, post-transplant weight gain and obesity, and the presence of pre-transplant diabetes. Because of safety concerns, there has been a consensus from 2003 onward to cease metformin as the first-line anti-diabetic drug in patients with PTDM. The relationship between PTDM and metformin administration in high-risk renal transplant patients needs to be validated by more trial studies to establish the risk-benefit balance using this drug. Here, we reviewed the pros and cons of using metformin by presenting conclusions from several retrospective and clinical trial studies.
Highlights
In patients with renal failure, kidney transplantation has boosted the survival and quality of life and decreased expenses on time compared to dialysis therapy
New-onset diabetes after transplantation (NODAT) For durable and successful grafts, it is of critical importance to monitor and control blood glucose level after transplantation
The search was conducted by using combinations of the following key words and or their equivalents; post-transplant diabetes mellitus, insulin resistance, new-onset diabetes after transplantation, diabetes mellitus, transplantation, immunosuppressive drugs, obesity, cardiovascular diseases, inflammation, metformin, lactic acidosis, end-stage renal disease, cancer, liver failure, renal transplantation, kidney failure, nephroprotection, glomerular filtration rate, nephrotoxicity,pre-transplant diabetes and AMPactivated protein kinase (AMPK)
Summary
In patients with renal failure, kidney transplantation has boosted the survival and quality of life and decreased expenses on time compared to dialysis therapy. Compared with normal population; graft recipients are at higher risk of death in particular secondary to cardiovascular events as the causes of half of all deaths in these patients. Transplantation candidates with diabetes have had augmented risk of cardiovascular diseases and inflammation compared with nondiabetic individuals undergoing solid organ transplantation. New-onset diabetes after transplantation (NODAT) For durable and successful grafts, it is of critical importance to monitor and control blood glucose level after transplantation. The NODAT seems to be the main culprit for cardiovascular related death in kidney transplant recipients. PTDM as a prevalent condition inflicts up to 50% of renal transplanted patients and augments the risks of cardiovascular diseases, graft and mortality. Poor controlling of blood glucose level after renal transplantation has been related to adverse transplant outcomes.
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