In his recent celebration of the 50th anniversary of the first successful transplantation of a human kidney, Sir Peter Morris chronicled the events that have turned solid-organ transplantation into a routine procedure. 1 Short-term success rates have improved dramatically since the early days, partly due to improvements in surgical techniques but also through the development of more effective immunosuppressive agents. The first anti-T-cell immunophilin, ciclosporin, was introduced in the early 1980s; until then, corticosteroids and azathioprine had been the mainstays of antirejection therapy. 1 Ciclosporin was followed a decade or so later by another potent immunophilin, tacrolimus. These drugs, also known as calcineurin inhibitors, are widely regarded as having revolutionised immunosuppression for organ transplantation. However, each has a narrow therapeutic index and blood levels have to be carefully monitored. 2

A major challenge facing transplant clinicians in the 21st century is reducing the risk of long-term complications that contribute to graft loss or premature death of the recipient. Relevant here is new-onset diabetes mellitus after transplantation. This concern was highlighted in consensus guidelines on diagnosis and management. 3 In kidney-transplant recipients, new-onset diabetes is associated with reduced survival