New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis.
New onset diabetes mellitus (NODM) is a serious complication of transplantation. This meta-analysis evaluates the reported incidence of NODM after solid organ transplantation in patients receiving CNI treatment. Databases from January 1992 to April 2002 were searched. Fifty-six publications providing NODM incidence data were reviewed. Sixteen prospective, randomized comparative studies providing information on incidence of insulin-dependent diabetes mellitus (IDDM) were subjected to meta-analysis. New onset diabetes mellitus was reported in 13.4% of patients after solid organ transplantation, with a higher incidence in patients receiving tacrolimus than cyclosporine (16.6% vs. 9.8%). This trend was observed across renal, liver, heart and lung transplant groups. Meta-analysis of 16 studies included patients receiving either tacrolimus (n=1636) or cyclosporine (n=1407). The incidence of IDDM was significantly higher among tacrolimus-treated patients (10.4% vs. 4.5%, p<0.00001), an effect observed in renal (9.8% vs. 2.7% p<0.00001) and nonrenal (11.1% vs. 6.2%; p<0.003) groups, and among patients receiving equal doses of concomitant medication in both treatment arms (12.0% vs. 3.0%; p<0.00001). The reported incidence of NODM during the past decade was significantly higher among patients receiving tacrolimus than cyclosporine. These data provide a quantitative foundation for studies designed to reduce the rates of NODM following solid organ transplantation.
Heisel
Olaf
O
Department of Pathology and Laboratory Medicine, University of British Columbia, Canada.
Heisel
Rochelle
R
Balshaw
Robert
R
Keown
Paul
P
D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000009:adverse effects; D003920:Diabetes Mellitus / Q000209:etiology*; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016377:Organ Transplantation / Q000009:adverse effects; D011446:Prospective Studies; D012189:Retrospective Studies; D016559:Tacrolimus / Q000009:adverse effects; D013997:Time Factors
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D016559:Tacrolimus