移植后糖尿病

Post-transplant diabetes mellitus

随着手术技术和抗排斥药物的发展,器官移植的成功率大大提高。与此同时,罹患代谢性疾病的移植受者数量也急剧增加。移植后糖尿病(PTDM)是实体器官移植后常见的并发症,增加移植物丢失、心血管疾病的发生率和死亡率。PTDM的危险因素包括高龄、基因背景、肥胖、HCV感染和某些免疫抑制剂(糖皮质激素、钙调神经磷酸酶抑制剂、哺乳动物雷帕霉素靶蛋白抑制剂)。PTDM的管理和治疗应当始于移植手术实施之前,对高危受者应详细筛查。PTDM的治疗与2型糖尿病相似,但有其特殊性,需综合考虑抗排斥药物、降糖药的相互作用及移植器官的排斥风险和器官功能的变化。

With the development of surgical technique and immunosuppressants,the success rate of organ transplantation has been increasing. Meanwhile,the number of transplant recipents suffered from metabolic diseases is growing fast.Post-transplant diabetes mellitus（ PTDM） is a common complication after solid organ transplantation and is associated with risks of graft loss,cardiovascular morbidity and mortality. Risk factors for PTDM include older age,genetic background,obesity,hepatitis C virus infection and use of immunosuppressant agents（ corticosteroids,calcineurin inhibitors,and mammalian target of rapamycin inhibitor）.Management of PTDM should be started before the transplantation plan to properly screen high risk patients. Even though PTDM management is similar to that of general type 2 diabetes,therapeutic approaches must be made with consideration of drug interactions between immunosuppressive agents,glucoselowering medications,and graft rejection and function.