Pediatric post-transplant diabetes: data from a large cohort of pediatric heart-transplant recipients.
A retrospective analysis of 381 pediatric heart-transplant recipients was performed to determine the frequency, characteristics, and risk factors for post-transplant diabetes. The rate of post-transplant diabetes was 1.8% with antithymocyte globulin, cyclosporine and azathioprine as primary immunosuppressive therapy. Time from transplant to diabetes was 0.25-13 years. Diabetes was characterized by reversibility, and lack of insulinopenia and autoimmunity. The post-transplant diabetes rate in tacrolimus-converted children (n = 45) was 8.8%. In tacrolimus-converted children, age at transplant, mean and maximum tacrolimus blood levels, and first-year rejection episodes were higher in the post-transplant diabetes group, which also consistently had DR-mismatched transplants and HLA DR3/DR4 haplotypes. Body mass index was not different between diabetic and control tacrolimus-converted children. In conclusion, pediatric post-transplant diabetes may be related to reversible insulin resistance. Tacrolimus levels, HLA DR mismatch, and older age at transplant may predispose to post-transplant diabetes.
Hathout
Eba H
EH
Pediatric Diabetes Center & Pediatric Heart Transplant Program, Loma Linda University Children's Hospital, California, USA. EHATHOUT@AHS.LLUMC.EDU
Chinnock
Richard E
RE
Johnston
Joyce K
JK
Fitts
James A
JA
Razzouk
Anees J
AJ
Mace
John W
JW
Bailey
Leonard L
LL
D000293:Adolescent; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001379:Azathioprine / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D016572:Cyclosporine / Q000008:administration & dosage; D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D016027:Heart Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007223:Infant; D008297:Male; D012189:Retrospective Studies
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D001379:Azathioprine