Approximately 20% of post-transplant patients develop hyperglycemia, and 5-10% require therapy with oral hypoglycemic agents or insulin. Transient tubular glycosuria is also common.
Corticosteroid therapy is the most frequent cause of post-transplantation hyperglycemia. Steroids may increase production of glucose from gluconeogenesis, impair peripheral use of glucose, and cause elevation of glucogen levels by a direct anti-insulin effect at the cellular level. An undetermined threshold dose of corticosteroid may be required to provoke diabetes in susceptible individuals. Some studies have shown post-tranpslant diabetes to be related to steroid does, increased patient age, black race, a positive family history of diabetes, increased body weight, and human leukocyte antigen A28. These findings have not been consistent.
Typically, the onset of steroid diabetes is mild, without associated ketoacidosis; it may resolve on withdrawal or reduction of the steroid dose. Both cyclosporine and tacrolimus contribute to glucose intolerance by inhibiting insulin secretion by pancreatic beta cells and by inducing peripheral insulin resistance. Animal studies have revealed a decrease in islet cell insulin content as well as a severe degranulation and hydropic degeneration of islet cells after treatment with cyclosporine. Human studies have shown both improved glucose tolerance curves and insulin output after conversion from cyclosporine to azathioprine and prednisone. Cyclosporine dose reduction may improve glucose intolerance.
You should speak with your physician about your interest in transplantation, and obtain further information about the success of transplantation, types of donors and the complications of transplantation. You should also seek a willing donor among your relatives, and discuss the type of donor, living related or cadaver you would like with your family and physician. You can assure family members htat a physician will not accept a kidney from a living donor if they believe that there is significant risk to that donor.
If you are to receive a living donor kidney, the following will be arranged and completed prior to transplant:
tissue typing from both yourself and the potential donor
full donor workup or medical evaluation
periodic physical examinations by the local nephrologist or transplant center
blood tests and X-rays (other types of tests may also be required)
If you are receiving a transplant from a cadaver, the following will be completed before your name is placed on a waiting list:
you are tissue-typed and the results are placed in a computer with other names on the waiting list
a tube of blood serum must be sent regularly from the dialysis center to the tissue-typing laboratory for sensitivity screening
periodic physical examinations, X-trays and blood tests are ordered
Also, the hospital or dialysis center must be assured of your whereabouts by receiving the telephone numbers and addresses so that you can be reached in the event a kidney becomes available.
If a Cadaver Kidney Becomes Available
You will be notified when a potential kidney becomes available. Once notified, you should stay close to a phone to receive information on the time of hospital admission. Arrangements for traveling to the hospital should be made and you will probably be told not to eat or drink anything in preparation for the surgery. You may need to be dialyzed before the surgery depending upon when you were last dialyzed, your blood chemistries and your general medical condition.