title: A low incidence of new-onset insulin-dependent diabetes mellitus using tacrolimus in kidney recipients in Europe.
abstract: Employing tacrolimus (Tac) for routine immunosuppression in renal transplantation (RT), produced an incidence of new-onset, insulin-treated, diabetes mellitus (newDM) as high as 20%. More recently, several large multicenter kidney studies using Tac as the primary immunosuppressant have been reported in Europe. Between 1997 and 2001, we performed 155 RTs using Tac (0.2 mg/k/per day, targeting whole blood trough levels <15 ng/mL) with a rapid steroid taper. The acute rejection rate was 13%, and 89% of grafts are still functioning. Only 5 Tac-treated patients not previously requiring insulin needed insulin therapy for > or =30 days (3.2%). Eight separate studies employing Tac in at least one arm (N=2728) have been reported between 1997 and 2002. Tac was combined with azathioprine or MMF, and/or steroids. The incidence of new DM at study end ranged from 2.3% to 8.3%. The only trial with >6% incidence was the first one, using an initial dose of 0.3 mg/kg per day. The most recent studies utilized an initial dose of 0.2 mg/kg per day, targeting whole blood trough levels of <15 ng/mL and a steroid taper, with newDM at <6%. On the basis of these data, we confirm in that the use of Tac as a first-line immunosuppressant in renal transplant patients affords protection against acute rejection with a low level of newDM. The tendency to employ lower oral doses of Tac, lower blood target levels, and a reduced steroid dose appear to minimize glucose disturbances in RT.
authors.affiliation: Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain. ipascual.hrc@salud.madrid.org
authors.forename: J
authors.initials: J
authors.lastname: Pascual
authors.forename: R
authors.initials: R
authors.lastname: Marcén
authors.forename: F J
authors.initials: FJ
authors.lastname: Burgos
authors.forename: A
authors.initials: A
authors.lastname: Tato
authors.forename: M T
authors.initials: MT
authors.lastname: Tenorio
authors.forename: F
authors.initials: F
authors.lastname: Liaño
authors.forename: J
authors.initials: J
authors.lastname: Ortuño
mesh_terms: D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000517:prevention & control; D005060:Europe; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus