[Relationship between ADPKD and post renal transplant diabetes mellitus]

Autosomal-dominant polycystic kidney disease [ADPKD], a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease [ESRD] by the fifth decade of life. Post-transplant diabetes mellitus [PTDM], a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients. In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients [27 ADPKD and 113 non ADPKD patients] were enrolled during three years. Both groups were matched for age, sex, body mass index [BMI], duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months. PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant [P > 0.05]. The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels [P > 0.05]. Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease

newest medications in kidney transplantation and their mechanisms of action

In recent years, many new immunosuppressive drugs have been discovered and developed for clinical use in transplantation. This review focuses on new drugs and novel strategies that have been shown to have immunosuppressive activity in patients. The literature was reviewed. The introduction of cyclosporine in the early 1980s improved renal allograft survival by approximately 15 percent at one year post transplant. However, cyclosporine failed to enhance long term graft survival. In addition, transplant recipients are at risk of significant side effects due to immunosuppression, including infection, cardiovascular disease, hypertension and malignancy. The limitations constitute the rational for the continued development of new immunosuppressive agents. The therapeutic armamentarium for transplant immunosuppression continues to broaden and become more complex, as does the variety of potential drug combinations or protocols. Further studies in a large number of individuals is required to clarify the role of new immunosuppressive agents and novel strategies in transplant recipients