Diabetes mellitus after transplant: relationship to pretransplant glucose metabolism and tacrolimus or cyclosporine A-based therapy.
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.
Sato
Tetsuhiko
T
Surgery of Renal Center, Nagoya Daini Red Cross Hospital, Nagoya, Japan. tetsugar@hotmail.com
Inagaki
Akemi
A
Uchida
Kazuharu
K
Ueki
Tsuneo
T
Goto
Norihiko
N
Matsuoka
Susumu
S
Katayama
Akio
A
Haba
Toshihito
T
Tominaga
Yoshihiro
Y
Okajima
Yoshiki
Y
Ohta
Kimiko
K
Suga
Hidetaka
H
Taguchi
Seiko
S
Kakiya
Satoshi
S
Itatsu
Takeharu
T
Kobayashi
Takaaki
T
Nakao
Akimasa
A
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism*; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D003710:Demography; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D007674:Kidney Diseases / Q000145:classification / Q000601:surgery; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D019520:Living Donors; D008297:Male; D018579:Patient Selection; D016559:Tacrolimus / Q000627:therapeutic use*
D000959:Antihypertensive Agents; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine; D016559:Tacrolimus