sechenovSechenov Medical JournalСеченовский вестник2218-73322658-3348Сеченовский Университет10.47093/2218-7332.2021.12.1.60-73sechenov-202Research ArticleINTERNAL MEDICINEВНУТРЕННИЕ БОЛЕЗНИInterdisciplinary problem of post-transplant diabetes mellitus: literature reviewПосттрансплантационный сахарный диабет как мультидисциплинарная проблема: обзор литературыhttps://orcid.org/0000-0003-0809-0787БалашоваА. В.BalashovaA. V.

Балашова  Анастасия  Владимировна,  ассистент  кафедры эндокринологии № 1

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

+7 (916) 102-67-60

Anastasiya  V.  Balashova, Assistant Professor, Endocrinology Department № 1

8/2, Trubetskaya str., Moscow, 119991

+7 (916) 102-67-60

nasta6koklina@mail.ruhttps://orcid.org/0000-0003-4298-0329МустафинаВ. Р.MustafinaV. R.

Мустафина Виолетта Рафаэлевна, ординатор

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Violetta  R.  Mustafina, Resident

8/2, Trubetskaya str., Moscow, 119991

violetta-mustafi@mail.ruhttps://orcid.org/0000-0001-8505-5526ГлинкинаИ. В.GlinkinaI. V.

Глинкина Ирина Владимировна,  канд.  мед.  наук,  доцент кафедры эндокринологии № 1

ул. Трубецкая, д. 8, стр. 2, г. Москва, 119991

Irina V. Glinkina, Cand. of Sci. (Medicine), Associate Professor, Endocrinology Department № 1

8/2, Trubetskaya str., Moscow, 119991

irina_glinkina@rambler.ruФГАОУ ВО «Первый Московский государственный медицинский университетим. И.М. Сеченова» Минздрава России (Сеченовский университет)РоссияSechenov First Moscow State Medical University (Sechenov University)Russian Federation2021290420211216073Copyright © Balashova A.V., Mustafina V.R., Glinkina I.V., 20212021Балашова А.В., Мустафина В.Р., Глинкина И.В.Balashova A.V., Mustafina V.R., Glinkina I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sechenovmedj.com/jour/article/view/202

The number of transplantation and transplant survival rates increase steadily. Patients after solid organ transplantation re-ceive lifelong immunosuppressive therapy which may have adverse effects on carbohydrate and lipid metabolism. The most diabetogenic drugs are calcineurin inhibitors and corticosteroids. Posttransplant diabetes mellitus (PTDM) is hyperglycemia that meets American Diabetes Association and World Health Organization diabetes criteria for nontransplant patients and that was newly diagnosed after transplantation. PTDM may worsen both short-term and long-term transplantation outcomes so that the problem of timely diagnosis, proper treatment and prevention is critical. In early post-transplant period, transient hyperglycemia is found in the vast majority of patients; therefore, PTDM screening is carried out at least one month after transplantation. The gold standard test for PTDM diagnosis is oral glucose tolerance test. In the same time diagnostic value of hemoglobin A1C is limited. Lifestyle therapy and antidiabetic drugs are considered as possible preventive measures. Stress induced hyperglycemia management in solid organ recipients is the same with other surgical patients. Which organ was transplanted, patient characteristics and possible drug interactions with immunosuppressive therapy should be taken into account while managing PTDM. Blood pressure and lipid profile should be under control for comprehensive cardiovascu-lar risk reduction. It remains unclear which PTDM treatment and prevention strategy is the best and for better understanding interdisciplinary approach is needed.

Ежегодно растёт как количество проводимых трансплантаций, так посттрансплантационная выживаемость. Реципиенты солидных органов пожизненно получают иммуносупрессивную терапию (ИСТ), осложнениями которой являются нарушения углеводного и липидного обменов. Наиболее диабетогенными считаются препараты из группы ингибиторов кальциневрина  и глюкокортикостероиды. Посттрансплантационный сахарный диабет (ПТСД) – это повышение гликемии, соответствующее критериям СД, впервые выявленное после трансплантации. ПТСД может ухудшать как краткосрочные, так и отдалённые исходы трансплантации, что обуславливает необходимость его своевременной диагностики, терапии и профилактики. У большинства пациентов в раннем посттрансплантационном периоде выявляются транзиторные нарушения углеводного обмена, поэтому скрининг ПТСД проводится не ранее, чем через месяц после трансплантации. Предпочтительным методом диагностики считается пероральный глюкозотолерантный тест (ПГТТ), в то время как диагностическая ценность гликированного гемоглобина ограничена. К возможным превентивным мероприятиям в группе высокого риска относят модификацию образа жизни и назначение сахароснижающих препаратов. Коррекция стрессовой гипергликемии после трансплантации проводится по общим рекомендациям по ведению послеоперационных пациентов. При выборе сахароснижающих препаратов при ПТСД необходимо учитывать, какой орган был трансплантирован, особенности пациента и вероятность межлекарственных взаимодействий с ИСТ. Для снижения риска сердечно-сосудистых событий необходим контроль артериального давления и показателей липидного обмена. В лечении и профилактике ПТСД остаётся множество открытых вопросов, решение которых требует междисциплинарного подхода.

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The authors declare that there are no conflicts of interest present.