Post-transplant diabetes mellitus (PTDM) remains a frequent complication after renal transplantation, with potential implications for graft outcomes and post-transplant complications. A prospective observational cohort study published in Clinical Diabetology evaluated the incidence, associated risk factors, and clinical outcomes of PTDM in renal transplant recipients.

The analysis included 100 renal transplant recipients without pre-existing diabetes (mean age 38.5 ± 10.8 years; 73 men). Participants were followed during the first 6 months post-transplant to assess PTDM incidence, associated risk factors, infections, rejection episodes, and graft outcomes.

PTDM developed in 23% of patients within 6 months. Management included oral hypoglycemic agents in 17%, insulin in 4%, and combination therapy in 2%. Higher age, body weight, body mass index (BMI), and family history of diabetes were associated with PTDM. Pre-transplant hepatitis C virus infection showed higher odds of PTDM (OR 3.7). Tacrolimus trough levels were associated with PTDM, with a cutoff of 5.35 ng/mL showing sensitivity of 1.0, specificity of 0.91, and area under the curve (AUC) of 0.8 (p = 0.001).

PTDM was associated with higher rates of rejection (hazard ratio 37.6; p = 0.0001) and infections (43.5% vs 3.9%; AUC 0.67; p = 0.0001). Graft loss was higher in patients with PTDM (p = 0.024), while patient loss remained comparable between groups. These findings show that PTDM is associated with higher complication burden and adverse graft outcomes, highlighting the importance of early risk identification and post-transplant monitoring.