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New-onset diabetes after transplant (NODAT) in renal transplant recipients

Garry S Tobin, MD
Christina L Klein, MD
Daniel C Brennan, MD, FACP
Section Editors
Barbara Murphy, MB, BAO, BCh, FRCPI
David M Nathan, MD
Deputy Editor
Albert Q Lam, MD


Diabetes occurs in a substantial number of patients following renal transplantation. New-onset diabetes after transplant (NODAT) is associated with increased mortality and morbidity and, in particular, higher rates of cardiovascular disease and infection, which are the leading causes of death in renal transplant recipients.

This topic reviews the epidemiology, risk factors, and clinical implications of NODAT, as well as recommendations for screening and management. Issues relating to renal transplantation and combined kidney-pancreas transplantation in patients with preexisting diabetes are discussed elsewhere. (See "Renal transplantation in diabetic nephropathy" and "Benefits and complications associated with kidney-pancreas transplantation in diabetes mellitus" and "Patient selection for and immunologic issues relating to kidney-pancreas transplantation in diabetes mellitus".)


International consensus guidelines regarding the definition of new-onset diabetes mellitus after transplantation were originally published in 2003 [1,2]. Updated recommendations from an international consensus meeting were published in 2014 [3]. The use of various definitions prior to these publications made it difficult to assess the incidence of NODAT and the importance of different risk factors. (See 'Incidence' below and 'Risk factors' below.)

These guidelines use standard World Health Organization (WHO) and American Diabetes Association (ADA) criteria for the diagnosis of diabetes mellitus and impaired glucose tolerance [4]. (See "Clinical presentation and diagnosis of diabetes mellitus in adults", section on 'Diagnostic criteria'.)

Diabetes mellitus after transplantation may be diagnosed at any time after transplantation by any of the following:


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Literature review current through: Sep 2016. | This topic last updated: Oct 5, 2016.
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