POST-TRANSPLANT DIABETES MELLITUS (PTDM) IN PATIENTS AFTER LIVER TRANSPLANTATION – DIAGNOSIS AND TREATMENT

Liver transplantation is an effective method for treating end-stage liver failure and certain liver cancers. Survival after this procedure is associated with the development of comorbidities, including before diagnosed diabetes mellitus and new diagnosed post-transplant diabetes mellitus (PTDM). Its pathophysiology differs from that of type 2 diabetes in the general population and reflects a complex interplay between pre-existing metabolic vulnerability (e.g. obesity, insulin resistance, impaired fasting glucose), perioperative stressors, and chronic immunosuppression. Commonly used immunosuppressive drugs, such as calcineurin inhibitors (particularly tacrolimus), mTOR inhibitors, and glucocorticosteroids, affect not only pancreatic function but also contribute to weight gain and chronic inflammation. Therapeutic goals should therefore be individualized according to time since transplantation, comorbidity burden, risk of hypoglycemia, and liver graft and renal function. Aim of the study: The objective of this study is to summarize recent literature on the diagnosis and treatment of PTDM and type 2 diabetes mellitus after liver transplantation. Materials and methods: In this narrative review, we searched the PubMed database to analyze the latest evidence on the treatment and diagnosis of PTDM, and type 2 diabetes mellitus diagnosed before liver transplantation. Results: We discuss diagnostic approaches as well as pharmacological and non-pharmacological treatment strategies for these metabolic disorders in patients receiving long-term immunosuppression. Conclusions: Interdisciplinary care and integration of lifestyle interventions are essential to optimize metabolic and cardiovascular risk management in liver transplant recipients. There remains a strong need for further clinical trials evaluating the safety and efficacy of oral antidiabetic agents in this specific patient population.