Cellular and organ transplantation have the highest rate of success when autologous or from a twin living donor with the notable exception of transplanting cells/organs in presence of autoimmunity. Autoimmunity recurrence make it always necessary the utilization of immunosuppressive agents. Endocrine organs are particularly susceptible to elicit antigens evoking auto-antibodies. Type 1 diabetes, Hashimoto thyroditis, Addison disease, celiac disease are all characterized by organ-specific autoimmunity.

Most immunosuppressive drugs have potent metabolic effects aside the immune-modulation effect. Therefore in endocrine diseases, the action of immunosuppressive drugs must be carefully balanced to avoid negative effects on the graft and the whole recipient as the development of de novo diabetes. The metabolic effects of immunosuppressive drugs will be presently reviewed systematically highlighting metabolic methodology required for correct assessment and follow up of the metabolic outcome of the graft.

Genetic and epigenetic factors of donor and recipient which may determine the final outcome of the graft will be reviewed. The panel of drugs and food integrators available to counteract metabolic effects of immune-suppression will be also reviewed.