New-onset diabetes after kidney transplant in children
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- 作者：Rouba Garro (1)
Barry Warshaw (1)
Eric Felner (2)
1. Department of Pediatrics ; Division of Nephrology ; Emory University ; 2015 Uppergate Drive NE ; Atlanta ; GA ; 30322 ; USA
2. Department of Pediatrics ; Division of Endocrinology ; Emory University ; Atlanta ; GA ; USA - 关键词：Kidney transplantation ; Diabetes ; New ; onset diabetes after kidney transplant ; Post ; kidney transplant glucose intolerance
- 刊名：Pediatric Nephrology
- 出版年：2015
- 出版时间：March 2015
- 年：2015
- 卷：30
- 期：3
- 页码：405-416
- 全文大小：412 KB
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- 刊物主题：Medicine & Public Health
Pediatrics - 出版者：Springer Berlin / Heidelberg
- ISSN：1432-198X
文摘
The development of new-onset diabetes after kidney transplantation (NODAT) is associated with reduced graft function, increased cardiovascular morbidity and lower patient survival among adult recipients. In the pediatric population, however, the few studies examining NODAT have yielded inconsistent results. Therefore, the true incidence of NODAT in the pediatric population has been difficult to establish. The identification of children and adolescents at risk for NODAT requires appropriate screening questions and tests pre- and post-kidney transplant. Several risk factors have been implicated in the pathogenesis of NODAT and post-transplant glucose intolerance, including African American race, obesity, family history of diabetes and the type of immunosuppressant regimen. Moreover, uremia per se results in a state of insulin resistance that increases the risk of developing diabetes post-transplant. When an individual becomes glucose intolerant, early lifestyle modification and antihyperglycemic measures with tailoring of the immunosuppressant regimen should be implemented to prevent the development of NODAT. For the child or adolescent with NODAT, antihyperglycemic therapy should be prescribed in order to achieve optimal glycemic control, ultimately reducing complications and improving overall allograft and patient survival. In this article, we review the risk factors, screening methods, diagnosis, management and outcome of children and adolescents with NODAT and post-kidney transplant glucose intolerance.