Organ transplantation offers life-saving treatment for end-stage organ disease, yet recipients face significant long-term complications. A critical concern is the development or exacerbation of diabetes, which is associated with adverse outcomes. Understanding and managing dysglycemia in this vulnerable population is essential for improving post-transplant survival and graft longevity.
Kidney transplantation, the most common solid organ transplant, carries a considerable burden of post-transplant diabetes mellitus (PTDM).1 PTDM is linked to increased cardiovascular events, graft dysfunction, and increased mortality.1 Poor perioperative glycemic control and glycemic variability have been associated with acute rejection and reduced graft survival.1
Continuous Glucose Monitoring in Transplant Recipients
Continuous glucose monitoring (CGM) has transformed diabetes management by offering real-time and dynamic insights into glucose variability, addressing limitations of traditional glucose assessment methods.1 A narrative review explored the role of CGM in kidney transplant recipients, particularly its impact on glycemic profiles and its predictive value for PTDM.1 At the time of this review, CGM had not yet been incorporated into standard transplant care protocols.1
Evidence shows that perioperative CGM outperforms traditional tests in identifying frequent hyperglycemia and glycemic variability in the first weeks after transplantation, enabling enhanced glycemic control and improving the recipient's clinical outcome.1 Studies demonstrate higher glucose variability in kidney-only recipients compared to other organ recipients, and in type 2 diabetes patients compared to those with PTDM.1 CGM-derived metrics outperform conventional glucose measures in predicting PTDM.1 CGM metric thresholds within the first month post-transplant achieved sensitivities above 85% and specificities up to 83% for PTDM risk.1 CGM-guided adjustment of immunosuppressants and steroid dosing have been shown to reduce hyperglycemia and variability.1 Comparative studies indicate that glycosylated hemoglobin A1c correlates poorly with CGM in the early post-transplant period, often misclassifying patients as normoglycemic.1 CGM appears to offer clinically relevant insights for the early detection, prediction, and management of dysglycemia in kidney transplant recipients.1
The evidence supporting continuous glucose monitoring (CGM) in kidney transplant recipients is compelling. The poor correlation of HbA1c with actual glycemic status in the early post-transplant period means that clinicians relying solely on this traditional marker may be missing critical periods of hyperglycemia and variability, directly impacting graft survival and patient mortality. Integrating CGM into perioperative care protocols for kidney transplant recipients seems a logical next step to improve glycemic control and potentially mitigate long-term complications.
For patients, this could mean earlier detection of PTDM risk and more precise management, leading to better clinical outcomes and potentially extending the life of their transplanted organ. The ability to adjust immunosuppressants and steroid dosing based on real-time glucose data offers a personalized approach to care that was previously unavailable. This shift from reactive to proactive glycemic management could significantly enhance patient quality of life post-transplant.
From an industry perspective, the increased adoption of CGM in transplant settings represents an expansion of its utility beyond conventional diabetes management. Device manufacturers should consider developing specific algorithms or features tailored to the unique physiological challenges of transplant recipients, such as interactions with immunosuppressive regimens. Guideline bodies, such as the American Society of Transplantation, should evaluate the current evidence to consider incorporating CGM into their recommendations for post-transplant care, thereby standardizing its use and ensuring equitable access.
- The Pivot Continuous glucose monitoring (CGM) offers superior detection of perioperative hyperglycemia and glycemic variability compared to traditional methods in transplant recipients.
- The Data CGM metric thresholds within the first month post-transplant achieved sensitivities above 85% and specificities up to 83% for PTDM risk.1
- The Action Clinicians should consider CGM for early detection and management of dysglycemia in kidney transplant recipients, as it provides insights that conventional tests like HbA1c may miss.
ART-2026-463
06/26
Cite This Article
Team TLSFE. Diabetes increases post-transplant mortality risk. The Life Science Feed. Updated June 21, 2026. Accessed June 21, 2026. https://thelifesciencefeed.com/endocrinology/diabetes-mellitus-type-2/research/diabetes-increases-post-transplant-mortality-risk.
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References
1. Oweidat K, Field BCT, Farmer CK. Continuous glucose monitoring in kidney transplant recipients: a narrative review. BMC Nephrol 2025.
