When patients receive an organ transplant, the body's immune system automatically tries to reject the new organ.  That is the body’s way to protect you from something foreign.  Maintenance immunosuppressive therapy (or anti-rejection medications) is administered to almost all renal transplant recipients to help prevent acute rejection and the loss of the transplanted organ.  As new medications are developed, the rates of success have improved in transplantation.  Overall, calcineurin inhibitors (CNi), such as cyclosporine (CsA) and tacrolimus remain the cornerstone of immunosuppression.  93% of all transplant patients are discharged after their transplant with a CNi regimen.

As short-term outcomes have improved, the attention of the transplant community has now shifted to reducing the long-term effects of chronic maintenance immunosuppression in an effort to increase long-term patient survival.  Those long term effects include NODAT (New Onset Diabetes Mellitus After Transplantation) cardiovascular disease, malignancies, and the creation of individualized immunosuppressive regimens.    

NODAT is increasingly recognized as an important and common complication following solid organ transplantation (up to 53% in some studies).  Patients with NODAT have increased cardiovascular mobidity, an increase in the potential for the loss of their transplanted organ, reduced transplant function, and an increase in the potential for death.  Finding a way to decrease NODAT is an important way to increase the potential for long-term patient survival.