Glucose metabolism before and after conversion from cyclosporine microemulsion to tacrolimus in stable renal recipients

Background. Tacrolimus is more diabetogenic than cyclosporine. However, this difference is only discernible in the first few months after renal transplantation. In randomized trials, investigating the effects of immunosuppression after renal transplantation, no increase in diabetes mellitus has been...

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Bibliographic Details
Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2008-02, Vol.23 (2), p.701-706
Main Authors: Gelens, Marielle A. C. J., Christiaans, Maarten H. L., van Hooff, Johannes P.
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
conversion
Cross-Over Studies
Cyclosporine - administration & dosage
cyclosporine/neoral
Emergency and intensive care: renal failure. Dialysis management
Emulsions
Female
Glucose - metabolism
Humans
Immunosuppressive Agents - administration & dosage
Intensive care medicine
ivGTT
Kidney Transplantation
Male
Medical sciences
Middle Aged
renal transplant
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the urinary system
tacrolimus
Tacrolimus - administration & dosage
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Summary:Background. Tacrolimus is more diabetogenic than cyclosporine. However, this difference is only discernible in the first few months after renal transplantation. In randomized trials, investigating the effects of immunosuppression after renal transplantation, no increase in diabetes mellitus has been reported. However, no sensitive technique was used in these trials, so subclinical alteration of glucose metabolism cannot be excluded. Methods. We, therefore, decided to use an intravenous glucose tolerance test (IV-GTT), to investigate whether conversion from cyclosporine-based immunosuppression, with a median trough level of 120 µg/l, to tacrolimus-based immunosuppression with a median trough level of 6.5 µg/l influences glucose metabolism and whether patients on steroids behave differently from those not on steroids. Results. Thirty stable, non-diabetic patients, transplanted 10 or more years earlier, were converted from cyclosporine to tacrolimus without changing their concomitant medication. IV-GTT's were performed before and 2.5 months after the conversion. Before conversion, 40% of the patients had an abnormal glucose disappearance rate (kG): in 7%, kG was below 0.8 (abnormal range) and in 34%, kG was between 0.8 and 1.2 (indeterminate range). After conversion, stimulated insulin production, kG, HbA1C and fasting glucose did not change significantly. Insulin resistance (HOMA-R) of the whole group increased significantly, mainly due to a rise in HOMA-R in patients on steroids (n = 18). None of these patients developed overt diabetes mellitus. Conclusions. Some 40% of long-term cyclosporine-treated patients had an abnormal glucose metabolism. Conversion from cyclosporine to tacrolimus does not negatively influence stimulated glucose metabolism or insulin resistance in stable, steroid-free renal transplant recipients. However, in patients receiving steroids, conversion leads to an increase in insulin resistance while insulin output remains the same.
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfm544