Metabolic Complications After Kidney Transplantation
Özet
Various metabolic complications are common in the post-kidney transplant period and can negatively impact patient and graft survival. The most important complications include post-transplant diabetes mellitus (PTDM), dyslipidemia, metabolic syndrome, and electrolyte imbalances. PTDM is defined as diabetes that develops after transplantation and is evaluated regardless of the time of onset. The presence of PTDM is associated with an increased frequency of infections, increased cardiovascular morbidity and mortality, and an increased risk of graft loss. Dyslipidemia is characterized by elevated levels of low-density lipoprotein cholesterol and triglycerides, particularly in response to immunosuppressive therapies. This contributes to the development of atherosclerotic cardiovascular disease and facilitates the development of metabolic syndrome. Metabolic syndrome is a complex clinical condition characterized by abdominal obesity, hypertension, hyperglycemia, and dyslipidemia, and is a significant risk factor for cardiovascular mortality in kidney transplant recipients. Electrolyte imbalances are also commonly observed in the post-kidney transplant period. Hyperkalemia, particularly due to calcineurin inhibitors reducing distal tubular potassium secretion, can lead to serious cardiac arrhythmias. Hypomagnesemia, on the other hand, results from multifactorial mechanisms such as renal magnesium loss, gastrointestinal malabsorption, and immunosuppressive drug use. Low magnesium levels increase the risk of developing PTDM through decreased insulin secretion and increased insulin resistance, and can also potentiate the diabetogenic effects of calcineurin inhibitors. Hypophosphatemia is frequently seen in the early post-transplant period and is associated with increased renal phosphate loss and persistent fibroblast growth factor-23 activity.
Referanslar
American Diabetes Association Professional Practice Committee for Diabetes*. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026. Diabetes Care. 2026 1;49:S27-S49.
Long J, Zhao J, Gu X, Huang C. Post-transplant diabetes mellitus after kidney transplantation: pathogenesis, risk factors, and management strategies. Front Endocrinol (Lausanne). 2026;17:1829579.
Barbachowska-Kubik AM, Gozdowska J, Kosieradzki M, Durlik M. Risk Factors for Development of Post-Transplant Diabetes Mellitus After Kidney Transplantation and Comparison Between Older and Younger Recipients in the Early Post-Transplantation Period: A Single-Center Study. Ann Transplant. 2025;30:e949855.
Kanbay M, Copur S, Topçu AU, et al. An update review of post-transplant diabetes mellitus: concept, risk factors, clinical implications and management. Diabetes Obes Metab. 2024;26(7):2531–2545.
Alajous S, Budhiraja P. New-onset diabetes mellitus after kidney transplantation. J Clin Med. 2024;13(7):1928.
Sharif A, Chakkera H, de Vries APJ, et al. International consensus on post-transplantation diabetes mellitus. Nephrol Dial Transplant. 2024;39(3):531–549.
American Diabetes Association Professional Practice Committee for Diabetes*. 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2026. Diabetes Care. 2026;49:S183-S215.
Çelik Kavaklılar B, Aybı Özdemir Ö, Yıldırım T, et al. Evaluation of microvascular complications in kidney recipients with posttransplant diabetes mellitus. J Clin Endocrinol Metab. 2024;109(8):e1623–e1633.
Jeon JY, Han-Bit S, Park BH, et al. Impact of post-transplant diabetes mellitus on survival and cardiovascular events in kidney transplant recipients. Endocrinol Metab (Seoul). 2023;38(1):139–145.
17. Agarwal A, Prasad GVR. Post-transplant dyslipidemia: Mechanisms, diagnosis and management. World Journal of Transplantation. 2016;6(1):125–134
18. Chmielnicka K, Heleniak Z, Dębska-Ślizień A. Dyslipidemia in renal transplant recipients. Transplantology. 2022;3(2):188–199.
19. Lentine KL, Brennan DC. Lipid abnormalities after kidney transplantation. UpToDate. Updated Jan 28, 2026. Accessed May 2026.
Pedrollo EF, Correa C, Nicoletto BB, et al. Effects of metabolic syndrome on kidney transplantation outcomes: a systematic review and meta-analysis. Transpl Int. 2016;29:1059–1066.
Graˇnák K, Vnuˇcák M, Belianˇcinová M, et al. Adiponectin/leptin ratio as an index to determine metabolic risk in patients after kidney transplantation. Medicina (Kaunas). 2022;58(11):1656.
Lee YH, Song SH, Song SH, et al. Clinical implications of changes in metabolic syndrome status after kidney transplantation: a nationwide prospective cohort study. Nephrol Dial Transplant. 2023;38:2743–2753.
Yan J, Yang X, Wang J, et al. Metabolic risk profile and graft function deterioration 2 years after kidney transplant. JAMA Netw Open. 2023;6(12):e2349538.
Zhu K, Jin Y, Liu W, et al. Clinical investigations and therapeutic perspectives on metabolic syndrome following kidney transplantation. Kidney Blood Press Res. 2025;50:232–239.
Naganuma T, Iwai T, Kabata D, et al. Impact of metabolic syndrome on renal and cardiovascular outcomes in renal transplant recipients: a single-center study in Japan. J Clin Med. 2025;14:5303.
Hamooya BM, Siame L, Muchaili L, et al. Metabolic syndrome: epidemiology, mechanisms, and current therapeutic approaches. Front Nutr. 2025;12:1661603.
Rizk JG, Lazo JG Jr, Quan D, et al. Mechanisms and management of drug-induced hyperkalemia in kidney transplant patients. Rev Endocr Metab Disord. 2021;22(4):1157–1170.
Garnier AS, Duveau A, Planchais M, et al. Serum magnesium after kidney transplantation: a systematic review. Nutrients. 2018;10(6):729.
Elshehawy M, Abdelgawad AA, Baig MY, et al. Hypomagnesaemia in renal transplant recipients: a review of mechanistic complexity, diagnostic gaps, and emerging therapeutic strategies. Kidney Dial. 2025;5(3):45.
Chen S, Bowen DG, Liu K, et al. Hypomagnesaemia, an independent risk factor for the development of post-transplant diabetes mellitus in liver and renal transplant recipients? A systematic review. J Hum Nutr Diet. 2024;37(6):1407–1419.
Vangala C, Pan J, Cotton RT, et al. Mineral and bone disorders after kidney transplantation. Front Med (Lausanne). 2018;5:211.
Teh JW, Mac Gearailt C, Lappin DWP. Post-transplant bone disease in kidney transplant recipients: diagnosis and management. Int J Mol Sci. 2024;25(3):1859.
Charoenngam N, Rittiphairoj T, Yingchoncharoen P, et al. Prognostic significance of hypophosphatemia in kidney transplant patients: a systematic review and meta-analysis. J Evid Based Med. 2025;18(1):e70000.
Ralston MR, Stevenson KS, Mark PB, et al. Clinical factors associated with severe hypophosphataemia after kidney transplant. BMC Nephrol. 2021;22(1):407.
