Diabetes and transplantation

Transplantation is both a cause of, and a therapy for, diabetes. Solid organ transplantation requires immunosuppressive regimens that frequently cause temporary or permanent hyperglycaemia, which can influence the outcome of allograft function and also increase cardiovascular mortality and morbidity. Post-transplant diabetes should be actively screened for and managed in the early post-transplant period, and should also be screened for long term in all solid organ transplant recipients. Transplantation of whole pancreas or pancreatic islets is a long-established therapy for people with type 1 diabetes (T1D) and severe hypoglycaemia unawareness. Both procedures may be done in association with other solid organ transplants, most commonly with kidney transplantation. They can induce insulin independence and improve allograft survival. Recently, stem cell-derived therapy for T1D has been shown to be possible in humans and is likely to become an important therapy for people living with T1D.