New-onset diabetes mellitus after kidney transplantation: the role of immunosuppression.
BACKGROUND
Complications related to posttransplantation immunosuppressive therapy remain common. New-onset diabetes mellitus after transplantation (PTDM) is a well-recognized complication associated with reduced graft and patient survival. The type of immunosuppression may be responsible for more than two thirds of PTDM. We retrospectively reviewed our experience in a population of 284 kidney transplant recipients, evaluating the incidence of PTDM with regard to the type of immunosuppression.


METHODS
From January 2001 to December 2005, 284 kidney transplantations were performed using tacrolimus-based (TAC) immunosuppression in 192 patients and a cyclosporine-based (CyA) regimen in 62 patients, whereas 30 patients received sirolimus-based immunosuppression.


RESULTS
The overall incidence of PTDM was 4.9%. Among the immunosuppression protocols, 8 patients (4.1%) received TAC and 6 patients (9.6%) received CyA, whereas no patients treated with sirolimus developed PTDM. Graft and patient survival rates were 93% and 100%, respectively.


CONCLUSIONS
The overall risk of PTDM with recent immunosuppressive protocols is low, but it is increased among calcineurin inhibitor (CNI)-treated kidney transplant recipients. Sirolimus did not increase the risk of PTDM, allowing potential clinical application in diabetic recipients and in patients affected by PTDM.
Veroux
M
M
Department of Surgery, Transplantation and Advanced Technologies-Organ Transplant Unit, University Hospital of Catania, Catania, Italy. veroux@unict.it
Corona
D
D
Giuffrida
G
G
Gagliano
M
M
Sorbello
M
M
Virgilio
C
C
Tallarita
T
T
Zerbo
D
D
Giaquinta
A
A
Fiamingo
P
P
Macarone
M
M
Li Volti
G
G
Caglia
P
P
Veroux
P
P
D016572:Cyclosporine / Q000009:adverse effects / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007328:Insulin / Q000172:deficiency / Q000378:metabolism; D007333:Insulin Resistance; D000078790:Insulin Secretion; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000276:immunology*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000276:immunology*; D011239:Prednisolone / Q000627:therapeutic use; D012189:Retrospective Studies
D007166:Immunosuppressive Agents; D007328:Insulin; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid