New-Onset Diabetes Mellitus After Kidney Transplantation: The Role of Immunosuppression

• Published in: Transplantation proceedings 2008-07, Vol.40 (6), p.1885-1887
• Main Authors: Veroux, M, Corona, D, Giuffrida, G, Gagliano, M, Sorbello, M, Virgilio, C, Tallarita, T, Zerbo, D, Giaquinta, A, Fiamingo, P, Macarone, M, Li Volti, G, Caglia, P, Veroux, P
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Cyclosporine - adverse effects; Cyclosporine - therapeutic use; Diabetes Mellitus - epidemiology; Diabetes Mellitus - immunology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunosuppression - adverse effects; Immunosuppressive Agents - adverse effects; Insulin - deficiency; Insulin - metabolism; Insulin Resistance; Insulin Secretion; Kidney Transplantation - adverse effects; Kidney Transplantation - immunology; Medical sciences; Middle Aged; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Postoperative Complications - immunology; Prednisolone - therapeutic use; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.06.005

Abstract 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. Patients and 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.