Posttransplant Diabetes in Pediatric Recipients on Tacrolimus

Shapiro, Ron; Scantlebury, Velma P.; Jordan, Mark L.; Vivas, Carlos; Ellis, Demetrius; Lombardozzi-Lane, Susan; Fung, John J.; Simmons, Richard L.; Starzl, Thomas E.

doi:10.1097/00007890-199903150-00025

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…The diabetogenic effect of several commonly used immunosuppressive drugs is well known and our results support several other reports including those in which steroids and/or tacrolimus were used as primary immune suppressants (4–6). In our study, steroid predominance at the outset, and tacrolimus use in the majority, might have contributed to the observed incidence of GI/PTDM.…”

Section: Discussionsupporting

confidence: 90%

“…Overall reported frequencies of PTDM in adults range from 4% to 40% (4), depending on the transplanted organ, definition of diabetes, and immunosuppressive regimen (5). Risk factors for PTDM include tacrolimus use (6), age at transplant, obesity, family history of diabetes, pre‐ and post‐transplant GI, ethnicity, and occasionally HLA sub‐types (7). The long‐term implications of pediatric PTDM, in terms of acceleration of known diabetic complications or development of new ones following decades of immune suppression remain to be discovered (8).…”

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confidence: 99%

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Post‐transplant diabetes mellitus in pediatric liver transplantation

Hathout

Alonso²,

Anand

et al. 2009

Pediatric Transplantation

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To determine the characteristics of pediatric liver transplant recipients who develop GI and/or PTDM, data on children undergoing their first liver transplant from the SPLIT database were analyzed (n = 1611). Recipient and donor characteristics that were evaluated included age at transplant, gender, race, primary disease, hospitalization status at transplant, BMI, recipient and donor CMV status, donor type, donor age, and primary immunosuppression. GI/PTDM was found in 214 individuals (13%) of whom 166 (78%) were diagnosed within 30 days of transplantation (early GI/PTDM). Multivariate analyses suggests that age >5 yr at transplant, hospitalization at transplant, a primary diagnosis other than BA, early steroid use, and tacrolimus use are associated with increased incidence of early GI. Routine monitoring for the development of GI and post-transplant diabetes is indicated in the short- and long-term care of children after liver transplantation.

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Section: Discussionsupporting

confidence: 90%

mentioning

confidence: 99%

Post‐transplant diabetes mellitus in pediatric liver transplantation

Hathout

Alonso²,

Anand

et al. 2009

Pediatric Transplantation

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“…We found the incidence of these side‐effects to be minimal. Diabetes mellitus has also been associated with tacrolimus therapy in up to 20% of patients (10). Typically, this occurs within the first few weeks after initiation of tacrolimus and usually resolves spontaneously within 6 months (2).…”

Section: Discussionmentioning

confidence: 99%

Tacrolimus: The good, the bad, and the ugly

Chand

Southerland

Cunningham

2001

Pediatric Transplantation

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The aim of this study was to evaluate the efficacy and side‐effects of tacrolimus in pediatric transplant patients previously receiving cyclosporin A (CsA). This study was a retrospective chart review strengthened by a concomitant patient interview. Eleven pediatric cardiac or renal transplant patients, who had been converted from CsA to tacrolimus from October 1995 to January 1999 at The Cleveland Clinic Foundation, were included; there were six renal and five cardiac transplant patients. Each chart was reviewed to assess transplanted organ function pre‐ and post‐conversion. For the six renal transplant patients, creatinine levels and biopsy findings were evaluated. For the five cardiac transplant patients, cardiac catheterization and routine biopsy data were analyzed likewise. Epstein–Barr virus (EBV) status was also evaluated in each patient. In addition, each parent or patient was interviewed to ascertain dates of transplant, current medications, and side‐effects. The patients' ages ranged from 6 to 20 yr (mean age 14.6 yr). All patients had been converted to tacrolimus. Eight patients were converted for treatment of refractory rejection, two were converted because of CsA‐associated side‐effects, and one patient was converted empirically for a history of multiple previous transplant rejections. Seven out of eight patients who received tacrolimus for rejection therapy improved. One patient had complete resolution of gingival hyperplasia. Another patient who previously developed hemolytic uremic syndrome on CsA had no further evidence of hemolysis. Four patients were weaned off steroid therapy. Despite conversion, two renal transplant patients progressed to chronic rejection. Five patients exhibited no side‐effects. Side‐effects experienced included transient hyperglycemia in conjunction with steroid use, headaches, and tremors that subsided rapidly. Four of 11 patients developed post‐transplant lymphoproliferative disease (PTLD). Fortunately, reducing the dose of tacrolimus and/or surgical resection of the mass (if present), eradicated the disease. In conclusion, conversion therapy successfully provides an alternate treatment for acute rejection. It also enabled some patients to discontinue steroid therapy, maximizing growth potential. PTLD is a severe, potentially life‐threatening complication that needs to be recognized and monitored closely. In conclusion, tacrolimus has been shown to be a very effective agent for the treatment of refractory organ rejection, but must be used cautiously.

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Pediatric renal transplantation: review of the recent literature

Shapiro¹

2000

Current Opinion in Organ Transplantation

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Posttransplant Diabetes in Pediatric Recipients on Tacrolimus

Cited by 5 publications

References 8 publications

Post‐transplant diabetes mellitus in pediatric liver transplantation

Post‐transplant diabetes mellitus in pediatric liver transplantation

Tacrolimus: The good, the bad, and the ugly

Pediatric renal transplantation: review of the recent literature

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