Diabetes mellitus after transplant: relationship to pretransplant glucose metabolism and tacrolimus or cyclosporine A-based therapy

Transplantation. 2003 Nov 15;76(9):1320-6. doi: 10.1097/01.TP.0000084295.67371.11.

Abstract

Objective: The purpose of this study was to identify pretransplantation and posttransplantation indicators for the development of diabetes mellitus in the first 2 months after renal transplantation and to examine the influence of a cyclosporine A (CsA)-based versus a tacrolimus-based immunosuppressive regimen on these risk factors.

Methods: Key variables associated with the development of posttransplant diabetes mellitus (PTDM) in the first 2 months after transplantation were assessed in 48 patients who underwent living-related renal transplantation and who were treated with a CsA-based or a tacrolimus-based immunosuppressive regimen. The insulinogenic index (I Index) and glucose infusion rate (GIR) were measures of insulin secretion and insulin sensitivity, respectively.

Results: Eight patients developed PTDM. I Index (odds ratio, 0.000384) and GIR (odds ratio, 0.349) were significant risk factors for PTDM development. The cumulative steroid dose had a borderline association. PTDM developed in 4 of 28 CsA-treated patients and in 4 of 20 tacrolimus-treated patients. CsA therapy increased the mean I Index from 0.713+/-0.071 preoperatively to 1.130+/-0.140 postoperatively (P<0.01), whereas in tacrolimus-treated patients, I Index remained unchanged (1.09+/-0.264 preoperatively and 0.949+/-0.296 postoperatively; P=not significant). Age, duration of pretransplant dialysis, and body mass index did not predict PTDM development. All eight patients with PTDM had hypertension.

Conclusions: Pre- and posttransplant abnormalities of insulin secretion and sensitivity are significant predictors of PTDM. Corticosteroid cumulative dose may affect the incidence of PTDM during the first 2 months after transplantation. CsA treatment increases insulin secretion in patients with a high pretransplant risk of PTDM.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Antihypertensive Agents / therapeutic use
  • Blood Glucose / metabolism*
  • Creatinine / blood
  • Cyclosporine / therapeutic use*
  • Demography
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / etiology
  • Female
  • Glucose Tolerance Test
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Insulin Resistance
  • Kidney Diseases / classification
  • Kidney Diseases / surgery
  • Kidney Transplantation / adverse effects*
  • Kidney Transplantation / physiology
  • Living Donors
  • Male
  • Patient Selection
  • Tacrolimus / therapeutic use*

Substances

  • Antihypertensive Agents
  • Blood Glucose
  • Immunosuppressive Agents
  • Cyclosporine
  • Creatinine
  • Tacrolimus