Increased Incidence of Insulin-Dependent Diabetes Mellitus in Pediatric Renal Transplant Patients Receiving Tacrolimus (Fk506)

Moxey-Mims, Marva; Kay, Cynthia; Light, Jimmy A.; Kher, Kanwal K.

doi:10.1097/00007890-199803150-00003

Cited by 39 publications

(21 citation statements)

References 9 publications

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“…We found that the overall rate of NODAT for these 2168 patients was 7.1% which is notably higher than the 2.6% rate previously observed in the North American Pediatric Renal Transplant Cooperative Study, the only other large-scale study conducted to date (11). Smaller studies have yielded inconsistent results with rates of NODAT ranging from 2–20% (12–14, 17, 23). Direct comparison of these studies is challenging due to notable differences in methodology, variables examined, sample size, patient age, and perhaps most importantly the criteria used to indicate NODAT.…”

Section: Discussionmentioning

confidence: 99%

Increasing Incidence of New-Onset Diabetes After Transplant Among Pediatric Renal Transplant Patients

et al. 2009

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Background Risk of new-onset diabetes after transplant (NODAT) is well characterized for adults but much less understood in pediatric transplant. This study examines the incidence and risk factors of NODAT in pediatric renal transplant patients. Methods The incidence of NODAT over the first three years following transplant were examined with United States Renal Data System data for primary renal transplant recipients (ages 0–21 years, transplanted between 1995 and 2004) with Medicare primary. Patients had no evidence of diabetes prior to transplant. We estimated the cumulative incidence rate and used Cox proportional hazards regression to identify risk factors for NODAT. Propensity scores were calculated for immunosuppression choice to adjust for potential confounding factors. Results 2168 recipients with valid immunosuppression records and without pretransplant evidence of diabetes were included. Unadjusted, cumulative NODAT incidence at three years posttransplant was 7.1%. Significant factors for increased risk of NODAT included Cytomegalovirus D+/R− serostatus (adjusted hazard ratio (aHR)=1.60), age 13–18 years (aHR=2.18), age 19–21 years (aHR=2.60), body mass index ≥ 30 (aHR=2.17) and use of tacrolimus (aHR=1.51). We failed to find any significant relationships between NODAT and graft failure/death. Conclusions While the incidence of NODAT among patients 0–21 years of age is lower than that for adult patients, it is higher than suggested by earlier research and may represent an increase over time. The lack of association between NODAT and graft/failure death has important implications for post-transplant care. A clearer understanding of risk factors can help guide posttransplant monitoring and clinical decision making.

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Section: Discussionmentioning

confidence: 99%

Increasing Incidence of New-Onset Diabetes After Transplant Among Pediatric Renal Transplant Patients

et al. 2009

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“…We read with interest the report by Moxey-Mims et aI., "Increased Incidence of Insulin-Dependent Diabetes Mellitus in Pediatric Renal Transplant Patients Receiving Tacrolimus (FK506)," reporting a 100% incidence of posttransplant diabetes mellitus in five pediatric patients receiving tacrolimusbased immunosuppression after renal transplantation (1). Although posttransplant diabetes mellitus (PTDM) has been a commonly observed complication in adult patients receiving tacrolimus, with an initial incidence of 6.0-28.3% and a final incidence of2.5-12.8% (2-9), it has been less common in pediatric patients, and has tended to be reversible in the overwhelming majority ofthe cases (10)(11)(12)(13).…”

Section: Postiransplant Diabetes In Pediatric Recipients On Tacrolimusmentioning

confidence: 99%

Posttransplant Diabetes in Pediatric Recipients on Tacrolimus

Shapiro¹,

Scantlebury²,

Jordan³

et al. 1999

Transplantation

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“…Tacrolimus has a similar side effect profile to CSA except for reduced cosmetic side effects and slightly decreased incidence of nephrotoxicity, hypertension, and dyslipidemia. However, its use is associated with an increased incidence of diabetes compared to CSA [22].…”

Section: Introductionmentioning

confidence: 99%

Mycophenolate mofetil therapy in frequently relapsing steroid-dependent and steroid-resistant nephrotic syndrome of childhood: current status and future directions

2005

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Clinicians are often faced with therapeutic dilemmas and challenges while treating children with frequently relapsing steroid-dependent nephrotic syndrome (SDNS) and steroid-resistant nephrotic syndrome (SRNS). In the past, children with SDNS have been treated with long-term alternate day steroids cyclophosphamide, cyclosporine (CSA), chlorambucil, levamisole, and azathioprine. The essential aim of these therapies is to maintain remission while limiting exposure to steroids. These medications have variable efficacy and undesirable toxicity profiles. Recently, mycophenolate mofetil (MMF) has emerged as a new therapeutic option for the management of SDNS in a few uncontrolled clinical trials. Preliminary data are encouraging. MMF was found to be useful in maintaining remission and has a steroid-sparing effect. Clearly, more data are needed to further characterize the safety and efficacy of MMF, define adequate length of treatment, and optimize drug exposure and monitoring. The management of SRNS is primarily aimed at decreasing proteinuria and inducing remission, if possible. By doing so, one would aim to preserve renal function. CSA therapy is known to be useful in this regard but has undesirable side effects, the most concerning being nephrotoxicity. MMF in combination with steroids and angiotensin-converting enzyme-inhibitor drugs is known to have some efficacy in the management of SRNS. These preliminary data have prompted the National Institutes of Health to sponsor a multicentric controlled trial to compare the safety and efficacy of MMF with that of CSA in the treatment of steroid-resistant focal segmental glomerulosclerosis (FSGS). If MMF therapy is found to be efficacious, it would help obviate the need for CSA and its associated nephrotoxicity. Clearly, MMF has emerged as an important new therapeutic option for the treatment of childhood nephrotic syndrome and FSGS. Further data are required to assess those conditions most likely to respond.

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Increased Incidence of Insulin-Dependent Diabetes Mellitus in Pediatric Renal Transplant Patients Receiving Tacrolimus (Fk506)

Abstract: Pediatric patients may be at high risk for developing FK506-induced IDDM.

Cited by 39 publications

References 9 publications

Increasing Incidence of New-Onset Diabetes After Transplant Among Pediatric Renal Transplant Patients

Increasing Incidence of New-Onset Diabetes After Transplant Among Pediatric Renal Transplant Patients

Posttransplant Diabetes in Pediatric Recipients on Tacrolimus

Mycophenolate mofetil therapy in frequently relapsing steroid-dependent and steroid-resistant nephrotic syndrome of childhood: current status and future directions

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