Post-transplant diabetes mellitus: mechanisms of development, risk factors, diagnosis, treatment

Abstract

The progressive increase in transplant activity is expected to increase the incidence of post-transplant complications, particularly post-transplant diabetes mellitus (PTDM). This review analyzes the epidemiology, risk factors, and key mechanisms for the development of this complication, such as immunosuppressive therapy-induced insulin resistance and impaired insulin secretion due to calcineurin inhibitor toxicity. Non-modifiable and modifiable risk factors are considered. Particular attention is paid to the evolution of terminology and diagnostic criteria PTDM, their specificity in the post-transplant period, and the role of continuous glycemic monitoring for active screening of recipients. A comparative analysis of current therapeutic approaches is presented, covering modifications of immunosuppressive regimens, non-pharmacological interventions, and the use of incretin mimetics, sodium-glucose cotransporter-2 inhibitors, and other hypoglycemic agents in this population. Further prospects in post-transplant patient management tactics are discussed — replacing drugs with less diabetogenic ones, improving immunosuppression protocols, a personalized approach, and early stratification of the risk of developing PTDM. The clinical significance of PTDM as a factor associated with a worse cardiovascular prognosis and reduced graft and recipient survival is emphasized. The need for interdisciplinary collaboration between transplant surgeons, endocrinologists and internists at all stages of patient management is substantiated — from pre-transplant assessment of metabolic status to long-term postoperative follow-up.