Work

Diabetes and transplantation

Year: 2025

Type: article

Abstract: • Post transplant hyperglycaemia and diabetes are common and should be actively sought and managed in all people undergoing solid organ transplantation. • Early insulin therapy may be required immediately post transplantation especially when immunosuppressive doses are high. • Metformin is an effective first line therapy if kidney function allows. • Use of sodium glucose transporter-2 inhibitors and incretin analogues may be beneficial in people with diabetes post kidney transplantation. • Whole pancreas and islet cell transplantation may be used in insulin deficient diabetes in people with poor hypoglycaemia awareness. • Simultaneous pancreas and kidney transplantation is an effective treatment for people with insulin deficient diabetes and chronic kidney disease. • Stem cell therapy for management of insulin deficient diabetes is becoming a reality. Transplantation is both a cause of, and a therapy for diabetes. Solid organ transplantation requires immunosuppressive regimens which frequently cause temporary or permanent hyperglycaemia which can influence the outcome of allograft function and also increase cardiovascular mortality and morbidity. Post-transplant diabetes should be actively screened for and managed in the early post-transplant period and should also be screened for long term in all solid organ transplant recipients. Transplantation of whole pancreas or pancreatic islets is a long-established therapy for people with Type 1 diabetes and severe hypoglycaemia unawareness. Both procedures may be done in association with other solid organ transplants, most commonly with kidney transplantation. They can induce insulin independence and improve allograft survival. Recently, stem cell derived therapy for Type 1 diabetes has been shown to be possible in humans and is likely to become an important therapy for people living with T1D.

Source: Clinical Medicine

DOI: 10.1016/j.clinme.2025.100514

Authors: Dorcas Mukuba, Ritwika Mallik, Tahseen A. Chowdhury

Institutions: Royal London Hospital, Queen Mary University of London, UCL Biomedical Research Centre, University College London

Language: English

Topic: Pancreatic function and diabetes

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,500