Is basiliximab induction, a novel risk factor for new onset diabetes after transplantation for living donor renal allograft recipients?

Prasad, Narayan; Gurjer, Desraj; Bhadauria, Dharmender; Gupta, Amit; Srivastava, Aneesh; Kaul, Anupama; Jaiswal, Akhilesh; Yadav, Brijesh; Yadav, Subhash; Sharma, Raj Kumar

doi:10.1111/nep.12209

Cited by 27 publications

(18 citation statements)

References 38 publications

(99 reference statements)

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“…In a meta-analysis of 10 studies, Fabrizi et al (121) reported an increased risk of PTDM in kidney transplant recipients with HCV infection compared to HCV-negative recipients (odds ratio, 3.97; 95% confidence interval, 1.83-8.61). HCV was also associated with risk after controlling for known risk factors in another cohort of 306 kidney transplant recipients (122) and a prospective observational trial (odds ratio, 6.37; 95% confidence interval, 2.28 -17.7) (123). As in liver transplant recipients, HCV-positive kidney recipients had reduced insulin sensitivity by minimal model estimate compared to matched HCV-negative patients (124).…”

Section: Potential Role Of "Stress" Inflammation and Infectionmentioning

confidence: 97%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

230

197

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and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. PTDM has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. An international consensus panel recommended a consistent set of guidelines in 2003 based on American Diabetes Association glucose criteria but did not exclude the immediate post-transplant hospitalization when many patients receive large doses of corticosteroids. Greater glucose monitoring during all hospitalizations has revealed significant glucose intolerance in the majority of recipients immediately after transplant. As a result, the international consensus panel reviewed its earlier guidelines and recommended delaying screening and diagnosis of PTDM until the recipient is on stable doses of immunosuppression after discharge from initial transplant hospitalization. The group cautioned that whereas hemoglobin A1C has been adopted as a diagnostic criterion by many, it is not reliable as the sole diabetes screening method during the first year after transplant. Risk factors for PTDM include many of the immunosuppressant medications themselves as well as those for type 2 diabetes. The provider managing diabetes and associated dyslipidemia and hypertension after transplant must be careful of the greater risk for drug-drug interactions and infections with immunosuppressant medications. Treatment goals and therapies must consider the greater risk for fluctuating and reduced kidney function, which can cause hypoglycemia. Research is actively focused on strategies to prevent PTDM, but until strategies are found, it is imperative that immunosuppression regimens are chosen based on their evidence to prolong graft survival, not to avoid PTDM. (Endocrine Reviews 37: 37-61, 2016)

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Section: Potential Role Of "Stress" Inflammation and Infectionmentioning

confidence: 97%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

230

197

View full text Add to dashboard Cite

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“…17 Considering the adverse consequences following NODAT, it is important that the association between HBV and HCV infection and incident NODAT in KTRs is well established. However, limited studies on HBV infection and incident NODAT are available to establish a reliable association between the two; it remains contentious whether HCV infection increases the risk of NODAT, with some studies reporting a significant correlation between the two, 2,4,[18][19][20][21] and others indicating no consistent association. [22][23][24][25][26] Moreover, whether coinfection with HBV and HCV exerts a greater effect on the development of NODAT than infection with each virus individually remains unclear due to the scarcity of relevant information.…”

Section: Introductionmentioning

confidence: 99%

Effects of preoperative hepatitis B virus infection, hepatitis C virus infection, and coinfection on the development of new‐onset diabetes after kidney transplantation

Liang

Chen

et al. 2018

Journal of Diabetes

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“…In the FREEDOM trial, which used a cyclosporine-based regimen, the de-novo use of antihyperglycemic medication was reduced from 14.7% to 4.5% when steroids were avoided [20]. While diabetogenic effects of steroids and CNIs are well documented, the role of IL2-R inhibitors in impairment of glucose homeostasis have been discussed, but the results are controversial [9,10]. …”

Section: Discussionmentioning

confidence: 99%

“…The steroid-free arm used daclizumab, tacrolimus and MMF, while the control arm used tacrolimus, MMF and steroids, without IL2-R antibody induction. In contrast, other studies have proposed that basiliximab, also an IL2-R antibody, impaired glucose homeostasis and was associated with an increased risk of NODAT [9,10]. …”

Section: Introductionmentioning

confidence: 97%

An in-progress, open-label, multi-centre study (SAILOR) evaluating whether a steroid-free immunosuppressive protocol, based on ATG induction and a low tacrolimus dose, reduces the incidence of new onset diabetes after transplantation

Ekberg

Jespersen

et al. 2014

Transplant Res

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BackgroundCorticosteroids and calcineurin inhibitors (CNIs) are included in renal transplantation immunosuppressive protocols around the world. Well-known side effects are associated with the use of these drugs, including new onset of diabetes after transplantation (NODAT). Long-term patient survival rates are lower among patients with NODAT. The optimal immunosuppressive protocol would therefore include not using corticosteroids and minimization of CNI use.Methods/DesignThis is a prospective, multi-centre, controlled, randomized, parallel group, open-label study involving kidney transplant patients. The study compares a steroid-free immunosuppressive protocol (study arm A), which is based on low-dose tacrolimus and mycophenolate mofetil (MMF) maintenance therapy together with antithymocyte globulin (ATG) induction, with the conventional immunosuppressive protocol (study arm B), being based on low-dose tacrolimus, MMF and steroids together with interleukin-2 receptor (IL2-R) induction. The study is designed to include most normal-risk patients. It will exclude patients seen as at a high risk of rejection. The primary objective of the study is to assess the cumulative incidence of NODAT in the two study arms 12 months after transplantation using the American Diabetes Association type 2 diabetes diagnostic criteria. The composite measure of freedom from acute rejection, graft survival and patient survival will be evaluated. Renal function and chronic changes in the transplanted kidney will be assessed.DiscussionIf this study confirms conceptual expectations, namely decreased incidence of NODAT, the steroid-free study protocol could be used with all patients. The regimen could be especially beneficial for patients at a high risk of diabetes mellitus.Trial registrationTrial registration: EudraCT 2012-000451-13.

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Is basiliximab induction, a novel risk factor for new onset diabetes after transplantation for living donor renal allograft recipients?

Abstract: Basiliximab induction prevents acute rejection; however, it is associated with increased risk of NODAT.

Cited by 27 publications

References 38 publications

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Effects of preoperative hepatitis B virus infection, hepatitis C virus infection, and coinfection on the development of new‐onset diabetes after kidney transplantation

An in-progress, open-label, multi-centre study (SAILOR) evaluating whether a steroid-free immunosuppressive protocol, based on ATG induction and a low tacrolimus dose, reduces the incidence of new onset diabetes after transplantation

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