title: Regression of new-onset diabetes mellitus after conversion from tacrolimus to cyclosporine in liver transplant patients: results of a pilot study.
abstract: BACKGROUND
  New-onset diabetes mellitus (NODM) has important implications for long-term outcome following liver transplantation.
  
  
  OBJECTIVE
  To evaluate the impact of conversion from tacrolimus to cyclosporine in liver transplant patients presenting NODM.
  
  
  METHODS
  In a 12-month pilot study, 39 liver transplant patients with NODM were converted from tacrolimus to cyclosporine. Most patients (59%) were receiving antidiabetic therapy (18% insulin, 41% oral) and all patients had received dietary advice prior to the study.
  
  
  RESULTS
  At month 12, NODM had significantly resolved (FBG<7 mmol/L without treatment) in 36% of patients (95% CI 20.8-51.0%). In the 16 patients not receiving antidiabetic drugs at baseline, mean FBG decreased from 8.1 mmol/L to 6.6 mmol/L (P=0.008) and mean HbA(1c) decreased from 6.4 to 6.0% (P=0.05). Steroids were stopped rapidly in the nine patients receiving steroids at inclusion but NODM resolution was observed in only one of these nine patients. No significant factors were identified that could have affected NODM resolution. There were three episodes of biopsy-proven acute rejection (7.7%), no graft losses and one death. Overall, cyclosporine tolerance was good with no significant change in creatinine clearance at month 12. Total cholesterol increased from 4.6 mmol/L to 5.1 mmol/L (P<0.001).
  
  
  CONCLUSIONS
  These results suggest that liver transplant patients with NODM may benefit from conversion to cyclosporine from tacrolimus through improved glucose metabolism. Confirmation in a prospective, randomized comparative study is required.
authors.affiliation: Hepatology and Liver Transplant Unit, Pontchaillou Hospital, 35033 Rennes cedex 9, France.
authors.forename: R
authors.initials: R
authors.lastname: Lorho
authors.forename: J
authors.initials: J
authors.lastname: Hardwigsen
authors.forename: J
authors.initials: J
authors.lastname: Dumortier
authors.forename: G-P
authors.initials: GP
authors.lastname: Pageaux
authors.forename: F
authors.initials: F
authors.lastname: Durand
authors.forename: T
authors.initials: T
authors.lastname: Bizollon
authors.forename: A-S
authors.initials: AS
authors.lastname: Blanc
authors.forename: F
authors.initials: F
authors.lastname: Di Giambattista
authors.forename: C
authors.initials: C
authors.lastname: Duvoux
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000469:Alkaline Phosphatase / Q000097:blood; D001663:Bilirubin / Q000097:blood; D002784:Cholesterol / Q000097:blood; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D006084:Graft Rejection; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects*; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D000305:Adrenal Cortex Hormones; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin; D016572:Cyclosporine; D002784:Cholesterol; D003404:Creatinine; D005723:gamma-Glutamyltransferase; D000469:Alkaline Phosphatase; D001663:Bilirubin; D016559:Tacrolimus