Long-Term Follow-up After Conversion From Tacrolimus to Cyclosporin in Renal Transplant Patients With New-Onset Diabetes Mellitus After Transplantation

Batista, Fatima; Auyanet, Ingrid; Torregrosa, José-Vicente; Oppenheimer, F

doi:10.1016/j.transproceed.2012.09.066

Cited by 8 publications

(4 citation statements)

References 5 publications

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“…[30][31][32][33] TAC therapy has been reported to cause new-onset diabetes mellitus and hyperuricemia more often in kidney transplant recipients. 34,35 Here, the number of patients with new-onset hyperuricemia was higher in the TAC group; however, in the majority of the patients, this was reversed after TAC discontinuation.…”

Section: Discussionmentioning

confidence: 80%

Tacrolimus Monotherapy after Intravenous Methylprednisolone in Adults with Minimal Change Nephrotic Syndrome

Liu

Wang

et al. 2016

JASN

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Glucocorticoid treatment is the first choice therapy for adults with minimal change nephrotic syndrome; however, this therapy associates with many adverse effects. Tacrolimus may be an alternative to conventional glucocorticoid therapy. To investigate this possibility, we conducted a prospective, randomized, controlled trial (WHO International Clinical Trials Registry Platform: ChiCTR-TRC-11001454) in eight renal units across China. We randomized enrolled patients with adult-onset minimal change nephrotic syndrome (=119) to receive glucocorticoid therapy or tacrolimus after intravenous methylprednisolone (0.8 mg/kg per day) for 10 days. Patients received a conventional glucocorticoid regimen or tacrolimus monotherapy, starting with 0.05 mg/kg per day (target trough whole-blood level of 4-8 ng/ml) for 16-20 weeks and subsequently tapering over approximately 18 weeks. Remission occurred in 51 of 53 (96.2%; all complete remission) glucocorticoid-treated patients and 55 of 56 (98.3%; 52 complete and three partial remission) tacrolimus-treated patients (=0.61 for remission; =0.68 for complete remission). The groups had similar mean time to remission (=0.55). Relapse occurred in 49.0% and 45.5% of the glucocorticoid- and tacrolimus-treated patients, respectively (=0.71), with similar time to relapse (=0.86). Seven (13.7%) glucocorticoid-treated and four (7.3%) tacrolimus-treated patients suffered frequent relapse (=0.28); five glucocorticoid-treated and two tacrolimus-treated patients became drug dependent (=0.26). Adverse events occurred more frequently in the glucocorticoid group (128 versus 81 in the tacrolimus group). Seven adverse events in the glucocorticoid group and two adverse events in the tacrolimus group were serious. Consequently, tacrolimus monotherapy after short-term intravenous methylprednisolone is noninferior to conventional glucocorticoid treatment for adult-onset minimal change nephrotic syndrome in this cohort.

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Section: Discussionmentioning

confidence: 80%

Tacrolimus Monotherapy after Intravenous Methylprednisolone in Adults with Minimal Change Nephrotic Syndrome

Liu

Wang

et al. 2016

JASN

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“…Finally, a conversion from TAC to cyclosporine, although potentially beneficial in short term [55], is not warranted in the long term, and a low-dose TAC regimen could expose patients to a higher risk of acute rejection [56]. …”

Section: Discussionmentioning

confidence: 99%

Conversion to Sirolimus Therapy in Kidney Transplant Recipients with New Onset Diabetes Mellitus after Transplantation

Veroux

Tallarita

Corona

et al. 2013

Clinical and Developmental Immunology

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New-onset diabetes mellitus after transplantation (NODAT) may complicate 2–50% of kidney transplantation, and it is associated with reduced graft and patient survivals. In this retrospective study, we applied a conversion protocol to sirolimus in a cohort of kidney transplant recipients with NODAT. Among 344 kidney transplant recipients, 29 patients developed a NODAT (6.6%) and continued with a reduced dose of calcineurin inhibitors (CNI) (8 patients, Group A) or were converted to sirolimus (SIR) (21 patients, Group B). NODAT resolved in 37.5% and in 80% patients in Group A and Group B, respectively. In Group A, patient and graft survivals were 100% and 75%, respectively, not significantly different from Group B (83.4% and 68%, resp., P = 0.847). Graft function improved after conversion to sirolimus therapy: serum creatinine was 1.8 ± 0.7 mg/dL at the time of conversion and 1.6 ± 0.4 mg/dL five years after conversion to sirolimus therapy (P < 0.05), while in the group of patients remaining with a reduced dose of CNI, serum creatinine was 1.7 ± 0.6 mg/dL at the time of conversion and 1.65 ± 0.6 mg/dL at five-year followup (P = 0.732). This study demonstrated that the conversion from CNI to SIR in patients could improve significantly the metabolic parameters of patients with NODAT, without increasing the risk of acute graft rejection.

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“…It has been proposed that cyclosporine should be considered for immunosuppression in patients with a greater diabetes risk due to a reduced risk in causing PTDM compared with tacrolimus [82]. However, over time glucose intolerance begins to manifest even with cyclosporine therapy [83].…”

Section: Individualized Immunosuppressive Therapymentioning

confidence: 99%

Post-Transplantation Diabetes Mellitus

et al. 2020

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Solid organ transplantation (SOT) is an established therapeutic option for chronic disease resulting from end-stage organ dysfunction. Long-term use of immunosuppression is associated with posttransplantation diabetes mellitus (PTDM), placing patients at increased risk of infections, cardiovascular disease and mortality. The incidence rates for PTDM have varied from 10 to 40% between different studies. Diagnostic criteria have evolved over the years, as a greater understating of PTDM has been reached. There are differences in pathophysiology and clinical course of type 2 diabetes and PTDM. Hence, managing this condition can be a challenge for a diabetes physician, as there are several factors to consider when tailoring therapy for post-transplant patients to achieve better glycaemic as well as long-term transplant outcomes. This article is a detailed review of PTDM, examining the pathogenesis, diagnostic criteria and management in light of the current evidence. The therapeutic options are discussed in the context of their safety and potential drug-drug interactions with immunosuppressive agents.

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Long-Term Follow-up After Conversion From Tacrolimus to Cyclosporin in Renal Transplant Patients With New-Onset Diabetes Mellitus After Transplantation

Cited by 8 publications

References 5 publications

Tacrolimus Monotherapy after Intravenous Methylprednisolone in Adults with Minimal Change Nephrotic Syndrome

Tacrolimus Monotherapy after Intravenous Methylprednisolone in Adults with Minimal Change Nephrotic Syndrome

Conversion to Sirolimus Therapy in Kidney Transplant Recipients with New Onset Diabetes Mellitus after Transplantation

Post-Transplantation Diabetes Mellitus

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