The Impact of Cyclosporine and Combination Immunosuppression on the Incidence of Posttransplant Diabetes in Renal Allograft Recipients

Boudreaux, J Philip; McHugh, Lois; Canafax, Daniel M.; Ascher, Nancy L.; Sutherland, David E.R.; Payne, W. T.; Simmons, Richard L.; Najarían, John S.; Fryd, David S.

doi:10.1097/00007890-198709000-00010

Cited by 191 publications

(100 citation statements)

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“…Many previous studies have reported that body weight is one of the risk factors for the development of PTDM (1,11,(25)(26)(27), whereas some studies have reported that the associations between PTDM and body weight or BMI are weak (5,20). As BMI is included in the equation for the dependent parameter ISI TX , a higher BMI is likely to be related to a greater reduction in insulin sensitivity.…”

Section: Incidences Of Different Categories Of Ptdmmentioning

confidence: 99%

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Hur

Kim

et al. 2007

Diabetes Care

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OBJECTIVE -The aim of this study was to assess the incidence of posttransplantation diabetes mellitus (PTDM) in renal allograft recipients and to investigate factors contributing to the onset and progression of PTDM and its underlying pathogenic mechanism(s).RESEARCH DESIGN AND METHODS -A total of 77 patients with normal glucose tolerance (NGT) were enrolled in this study. An oral glucose tolerance test was performed 1 week before transplantation and repeated at 1 and 7 years after transplantation.RESULTS -The overall incidence of PTDM was 39% at 1 year and 35.1% at 7 years posttransplantation. The incidence for each category of PTDM was as follows: persistent PTDM (P-PTDM) (patients who developed diabetes mellitus within 1 year of transplantation and remained diabetic during 7 years), 23.4%; transient PTDM (T-PTDM) (patients who developed diabetes mellitus during the 1st year after transplantation but eventually recovered to have NGT), 15.6%; late PTDM (L-PTDM) (patients who developed diabetes mellitus later than 1 year after transplantation), 11.7%; and non-PTDM during 7 years (N-PTDM 7 ) (patients who did not develop diabetes mellitus during 7 years), 49.3%. Older age (Ն40 years) at transplantation was a higher risk factor for P-PTDM, whereas a high BMI (Ն25 kg/m 2 ) and impaired fasting glucose (IFG) at 1 year posttransplantation were higher risk factors for L-PTDM. Impaired insulin secretion rather than insulin resistance was significantly associated with the development of Pand L-PTDM.CONCLUSIONS -Impaired insulin secretion may be the main mechanism for the development of PTDM. Older age at transplantation seems to be associated with P-PTDM, whereas a high BMI and IFG at 1 year after transplantation were associated with L-PTDM. Diabetes Care 30:609 -615, 2007P osttransplantation diabetes mellitus (PTDM) is a major complication after kidney transplantation and can lead to a wide range of complications including graft loss, increased mortality, increased number of rejections, and increased risk of cardiovascular disease (1-4). A recent meta-analysis of observational studies and randomized, controlled trials showed that the incidence of PTDM during the 1st year after transplantation varied from 2 to 50% (5). There have been several previous reports on PTDM in Korean patients, albeit for a short period of observation. We reported previously that the incidence of PTDM was 23.7% in 114 patients treated with cyclosporine A (CsA) at 9 -12 months after transplantation (6), whereas Cho et al. (7) reported that it was 57.1% in 21 patients treated with tacrolimus at 6 months after transplantation in Korea.PTDM and type 2 diabetes are similar in many ways. One example is that the onset of both can be insidious (8); individuals may experience glucose intolerance and remain asymptomatic for years before symptoms manifest clinically (9,10). Furthermore, PTDM is not always permanent and may resolve within weeks or months, sometimes without treatment (11). Although several recent reports on a consensus definition of PTDM ha...

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Section: Incidences Of Different Categories Of Ptdmmentioning

confidence: 99%

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Hur

Kim

et al. 2007

Diabetes Care

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“…Similarly, a recent registry analysis of data from Ͼ11,000 patients in the United States Renal Data System (USRDS) found that the risk for NOD increased by 53% when Tac was used as the initial maintenance immunosuppression (2). Another large registry study found that the difference in NOD between CsA and Tac occurs as soon as 3 mo after transplantation (3), a result confirmed by subsequent clinical trials (15)(16)(17).…”

mentioning

confidence: 93%

Influence of Early Posttransplantation Prednisone and Calcineurin Inhibitor Dosages on the Incidence of New-Onset Diabetes

Burroughs¹,

Lentine²,

Takemoto³

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…New-onset diabetes (NOD) is an increasingly common posttransplantation complication 1,2 that is associated with patient death, [3][4][5] graft loss, 6,7 and increased health care expenditures. 8 Several risk factors for NOD have been identified: Older age, 3,9,10 black race, 2,3,10 Hispanic ethnicity, 2,10 obesity, 2,6 family history of diabetes, 10 hepatitis C positivity, 2,11 and transplantation of a deceased-donor organ.…”

mentioning

confidence: 99%

“…8 Several risk factors for NOD have been identified: Older age, 3,9,10 black race, 2,3,10 Hispanic ethnicity, 2,10 obesity, 2,6 family history of diabetes, 10 hepatitis C positivity, 2,11 and transplantation of a deceased-donor organ. 3,10 In addition, the use of corticosteroids 12,13 and calcineurin inhibitors (CNI) has been associated with an increased risk for NOD. 2,14 -18 The higher risk for NOD in tacrolimus compared with cyclosporine A (CsA)-treated patients identified in observational studies 2 was recently confirmed in a randomized, controlled trial.…”

mentioning

confidence: 99%

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Johnston

Rose

Webster

et al. 2008

Journal of the American Society of Nephrology

376

238

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New-onset diabetes (NOD) is associated with transplant failure. A few single-center studies have suggested that sirolimus is associated with NOD, but this is not well established. With the use of data from the United States Renal Data System, this study evaluated the association between sirolimus use at the time of transplantation and NOD among 20,124 adult recipients of a first kidney transplant without diabetes. Compared with patients treated with cyclosporine and either mycophenolate mofetil or azathioprine, sirolimus-treated patients were at increased risk for NOD, whether it was used in combination with cyclosporine (adjusted hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.36 to 1.90), tacrolimus (adjusted HR 1.66; 95% CI 1.42 to 1.93), or an antimetabolite (mycophenolate mofetil or azathioprine; adjusted HR 1.36; 95% CI 1.09 to 1.69). Similar results were obtained in a subgroup analysis that included the 16,861 patients who did not have their immunosuppressive regimen changed throughout the first posttransplantation year. In conclusion, sirolimus is independently associated with NOD. Given the negative impact of NOD on posttransplantation outcomes, these findings should be confirmed in prospective studies or in meta-analyses of existing trials that involved sirolimus.

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The Impact of Cyclosporine and Combination Immunosuppression on the Incidence of Posttransplant Diabetes in Renal Allograft Recipients

Cited by 191 publications

References 0 publications

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Influence of Early Posttransplantation Prednisone and Calcineurin Inhibitor Dosages on the Incidence of New-Onset Diabetes

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

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