[Outcomes of conversion to sirolimus therapy for new-onset diabetes mellitus after kidney transplantation].
OBJECTIVE
To evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for treatment of new-onset diabetes after kidney transplantation (NODAT).


METHODS
Of 321 kidney transplant recipients, 34 patients who developed NODAT (10.59%) were divided into 3 groups to receive continued CNI therapy at a reduced dose (group A, 14 cases), sirolimus conversion therapy (group B, 12 cases), or oral hypoglycemic drugs (group C, 12 cases). All the patients had dietary and exercise therapies, and insulin injections were given in patients with postprandial (2 h) blood glucose over 14.0 mmol/L. The patients were followed up regularly for 5 years.


RESULTS
The mean blood glucose level was 13.02∓1.74 mol/L upon the diagnosis of NODAT in the 34 patients without significant differences between the 3 groups. At 6 months of therapy, fasting plasma glucose levels in the 3 groups decreased to 8.05 ∓2.45, 7.45∓2.44, and 9.30∓3.89 mmol/L, repsectively; at 12 months, blood glucose became normal in both groups A and B, but the patients in group A needed a greater daily insulin dose (P<0.05). In group B, the mean serum creatinine level was 165.1∓61.82 mmol/L at the conversion and lowered to 150∓53.05 mmol/L at 5 years (P<0.05), which were similar to those in group A at the two time points (152∓43.05 and 145.88∓53.05 mmol/L, respectively; P>0.05). In group C, creatinine level further increased after medication with oral hypoglycemic drugs. At 5 years, the patient and graft survival rates were 100% and 75% in group A, respectively, similar to those in group B (83.4% and 68%, respectively; P>0.05); group C showed lower patient and graft survival rates than groups B and C.


CONCLUSIONS
Conversion from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft rejection.
Southern Medical University, Guangzhou 510515, China. E-mail: skyyyjj123@126.com.
Yi
Y
Yu
Haibo
H
Nie
Wei
W
Wang
Weilie
W
Hu
Jun
J
Lv
D001786:Blood Glucose; D065095:Calcineurin Inhibitors / Q000627:therapeutic use; D003920:Diabetes Mellitus; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation; D020123:Sirolimus / Q000627:therapeutic use*
D001786:Blood Glucose; D065095:Calcineurin Inhibitors; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D020123:Sirolimus