Elahi T, Ahmed S, Mubarak M. Post-transplant metabolic dysregulation: Insights and implications for kidney graft survival. World J Nephrol 2026; 15(2): 118270 [DOI: 10.5527/wjn.v15.i2.118270]
Corresponding Author of This Article
Tabassum Elahi, Professor, Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. elahitabassum@gmail.com
Research Domain of This Article
Transplantation
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review-article
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Elahi T, Ahmed S, Mubarak M. Post-transplant metabolic dysregulation: Insights and implications for kidney graft survival. World J Nephrol 2026; 15(2): 118270 [DOI: 10.5527/wjn.v15.i2.118270]
World J Nephrol. Jun 25, 2026; 15(2): 118270 Published online Jun 25, 2026. doi: 10.5527/wjn.v15.i2.118270
Post-transplant metabolic dysregulation: Insights and implications for kidney graft survival
Tabassum Elahi, Saima Ahmed, Muhammed Mubarak
Tabassum Elahi, Saima Ahmed, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Author contributions: Elahi T, Ahmed S, and Mubarak M participated in the conceptualization and planning of the study; Elahi T and Ahmed S performed the literature search and prepared the initial draft of the manuscript; Mubarak M meticulously revised and refined the manuscript. All authors reviewed and approved the final version.
AI contribution statement: AI-based tools such as Grammarly were used. These tools were employed solely for language polishing and/or translation to improve readability and clarity.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Tabassum Elahi, Professor, Department of Nephrology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. elahitabassum@gmail.com
Received: December 28, 2025 Revised: January 27, 2026 Accepted: March 5, 2026 Published online: June 25, 2026 Processing time: 169 Days and 17.2 Hours
Abstract
Kidney transplantation is the preferred treatment for end-stage kidney disease, improving survival and quality of life. Yet, metabolic disorders including post-transplant diabetes mellitus, dyslipidemia, hyperuricemia, secondary hyperparathyroidism, and obesity are common in kidney transplant recipients and threaten graft function and patient outcomes. Post-transplant diabetes mellitus affects up to 30% of recipients within the first year, while transient hyperglycemia occurs in 60% of nondiabetic patients post-surgery. Dyslipidemia, obesity, and hyperuricemia exacerbate cardiovascular and metabolic risks, and secondary hyperparathyroidism impairs bone health and graft longevity. Immunosuppressive agents such as corticosteroids, calcineurin inhibitors, and mammalian target of rapamycin inhibitors contribute significantly to these complications, underscoring the need for tailored regimens. Management strategies should be comprehensive, combining lifestyle modification, pharmacological interventions (sodium-glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists), and, in selected cases, bariatric surgery. Close monitoring of post-transplant weight gain, particularly visceral fat, is essential to prevent insulin resistance and metabolic syndrome. Despite these advances, significant gaps persist in evidence-based guidelines, and emerging therapies alongside multidisciplinary collaboration hold promise in addressing these complex metabolic challenges. This review underscores the prevalence, pathophysiology, and clinical implications of post-transplant metabolic dysregulation, emphasizing the need for early detection, personalized management, and integrated care to optimize graft survival and long-term patient outcomes.
Core Tip: Kidney transplantation is the preferred treatment for patients progressing to end-stage kidney disease. Several metabolic processes are altered following kidney transplantation, primarily due to the overlap between preexisting risk factors and the side effects of immunosuppressive agents. Among the metabolic alterations, post-transplant diabetes, dyslipidemia, hyperuricemia, secondary hyperparathyroidism, and obesity are the most significant, given their clinical impact and their potential to threaten graft survival and patient outcomes. Lifestyle modification, pharmacological interventions such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, bariatric options, and close monitoring of weight gain are essential strategies, though evidence gaps remain, particularly in the management of hyperparathyroidism.
