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.