Glucose metabolism in renal transplant recipients on tacrolimus: the effect of steroid withdrawal and tacrolimus trough level reduction.
The relative role of steroids and tacrolimus in the development of glucose metabolic disorders and hyperlipidemia after renal transplantation has not yet been clearly established. Therefore, glucose metabolism was prospectively evaluated by intravenous glucose tolerance test, as was lipid profile, in fifteen white nondiabetic renal transplant recipients three times: before and after steroid withdrawal and after tacrolimus trough level reduction. After withdrawal of 10 mg of prednisolone, insulin resistance decreased (fasting C-peptide, 0.99 to 0.77 nmol/L [P < 0.0009]; fasting insulin, 9.5 to 8.1 mU/L [P = 0.09]; insulin/glucose ratio, 1.85 to 1.45 mU/mmol [P = 0.10]) and lipid levels decreased (total cholesterol, 5.1 to 4.2 mmol/L [P = 0.006]); HDL cholesterol, 1.4 to 1.1 mmol/L [P = 0.01]; LDL cholesterol, 3.0 to 2.5 mmol/L [P = 0.15]; triglycerides, 1.52 to 0.91 mmol/L [P = 0.02]). After tacrolimus trough level reduction from 9.5 to 6.4 ng/ml, pancreatic beta-cell secretion capacity improved (C-peptide secretion increased from 49.0 to 66.6 nmol x min/L [P = 0.04] and insulin secretion increased from 1134 to 1403 mU x min/L [P = 0.06]). HbA1c improved also, from 5.9 to 5.3% (P = 0.002). Lipids did not change. In conclusion, steroid withdrawal resulted in a decrease in insulin resistance and a reduction in lipids, and tacrolimus trough level reduction resulted in an improved pancreatic beta-cell secretion capacity. Therefore, these therapeutic measurements may contribute to the reduction of the cardiovascular morbidity and mortality in renal transplant recipients.
Boots
Johannes M M
JMM
Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
van Duijnhoven
Elly M
EM
Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.
Christiaans
Maarten H L
MHL
Wolffenbuttel
Bruce H R
BHR
van Hooff
Johannes P
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use; D005951:Glucose Tolerance Test; D006801:Humans; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D016030:Kidney Transplantation; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D016559:Tacrolimus / Q000097:blood / Q000627:therapeutic use*
D001786:Blood Glucose; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D008055:Lipids; D011239:Prednisolone; D016559:Tacrolimus