Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature

Authors: Ghisdal, Lidia1; Bouchta, Nora Ben1; Broeders, Nilufer1; Crenier, Laurent2; Hoang, Anh-Dung1; Abramowicz, Daniel1; Wissing, Karl Martin1

Source: Transplant International, Volume 21, Number 2, February 2008 , pp. 146-151(6)

Publisher: Wiley-Blackwell

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Abstract:

Summary

Tacrolimus (TRL) increases the incidence of new-onset diabetes mellitus after transplantation (NODAT). Little is known about whether conversion from TRL to cyclosporine A (CsA) improves glucose metabolism in patients with NODAT. We retrospectively analysed glucose metabolism parameters in 54 TRL-treated renal transplant patients who developed NODAT. Thirty-four were converted to CsA whereas 20 patients continued TRL. After conversion, fasting plasma glucose decreased from 146 ± 64 to 104 ± 20 mg/dl (P < 0.0001) and HbA1c levels decreased from 6.8 ± 0.8% to 6.0 ± 0.6% (P < 0.0001) after 1 year of follow-up. The remission rate of NODAT reached 42% (95% confidence interval 24–59%) 1 year after conversion versus 0% in the control group (P = 0.001). Blood pressure and lipid levels were stable after conversion although the use of statins significantly increased (P < 0.01). The conversion was safe in terms of graft function and acute rejection episodes. The 1-year patient survival and graft survival rate were 100%. In conclusion, our results suggest a significant improvement of glucose metabolism after conversion to CsA in renal transplant patients with NODAT.

Keywords: calcineurin inhibitors; cardiovascular diseases; diabetes mellitus; insulin; kidney transplantation; metabolic complications

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1432-2277.2007.00589.x

Affiliations: 1:  Department of Nephrology and Renal Transplantation, CUB Hopital Erasme, Bruxelles, Belgium 2:  Department of Endocrinology, CUB Hopital Erasme, Bruxelles, Belgium

Publication date: February 1, 2008

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