Conversion From Tacrolimus to Cyclosporin Is Associated With a Significant Improvement of Glucose Metabolism in Patients With New-Onset Diabetes Mellitus After Renal Transplantation

Bouchta, Nora Ben; Ghisdal, Lidia; Abramowicz, Daniel; Broeders, Nilüfer; Surquin, Murielle; Hoang, Anh Dung; Wissing, Karl Martin

doi:10.1016/j.transproceed.2005.03.137

Cited by 24 publications

(5 citation statements)

References 9 publications

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“…[17] If PTDM persists up to 12 months post transplant, it is unlikely to resolve; and switching to cyclosporine may be a valid therapeutic option; the reported success rate of this approach is (44-65%). [18][19][20] The choice of calcineurin inhibitor on the bases of diabetogenic risk should not be made at the expense of efficacy; measures such as steroid minimization or withdrawal and lower tacrolimus exposure may help maintain better long term survival.…”

Section: Discussionmentioning

confidence: 99%

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

El-Magzoub¹,

Elamin²

2010

Arab J. Nephr. Trans

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Section: Discussionmentioning

confidence: 99%

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

El-Magzoub¹,

Elamin²

2010

Arab J. Nephr. Trans

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“…Tacrolimus and CsA may cause NODAT by directly decreasing insulin secretion of pancreatic beta cells (489–493). Logically, reducing the dose or discontinuing these agents as soon as possible could potentially limit the damage to beta cells, although the clinical evidence is anecdotal (494,495). There is anecdotal evidence from case reports/series that NODAT may be reversed by reducing, replacing or discontinuing CsA, tacrolimus or corticosteroids (494,495).…”

Section: Rationalementioning

confidence: 99%

“…Logically, reducing the dose or discontinuing these agents as soon as possible could potentially limit the damage to beta cells, although the clinical evidence is anecdotal (494,495). There is anecdotal evidence from case reports/series that NODAT may be reversed by reducing, replacing or discontinuing CsA, tacrolimus or corticosteroids (494,495). There are few data on the effects of corticosteroid reduction on reversing NODAT once it has occurred.…”

Section: Rationalementioning

confidence: 99%

“…There are no RCTs testing whether changing to different immunosuppressive medication regimens reverses or ameliorates NODAT. There are uncontrolled (largely anecdotal) reports on the effects of changing immunosuppressive agents once NODAT has developed (494,495). Given the associations of NODAT with CsA, tacrolimus, mTORi and corticosteroids, it is plausible that reducing or eliminating these immunosuppressive medications may reverse or ameliorate NODAT.…”

Section: Rationalementioning

confidence: 99%

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Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

Eckardt¹,

Kasiske²,

Zeier³

2009

American Journal of Transplantation

1,205

294

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Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2009.02834.x S2 American Journal of Transplantation 2009; 9 (Suppl 3): S2-S2Since the first successful kidney transplantation in 1954 It is our hope that this document will serve several useful purposes. Our primary goal is to improve patient care. We hope to accomplish this in the short term by helping clinicians know and better understand the evidence (or lack of evidence) that determines current practice. By making this guideline broadly applicable, our purpose is to also encourage and enable the establishment and development of transplant programs worldwide. Finally, by providing comprehensive evidence-based recommendations, this guideline will also help define areas where evidence is lacking and research is needed. Helping to define a research agenda is an often neglected, but very important function of clinical practice guideline development.We used the GRADE system to rate the strength of evidence and the strength of recommendations. In all, there were only 4 (2%) recommendations in this guideline for which the overall quality of evidence was graded 'A,' whereas 27 (13.6%) were graded 'B,' 77 (38.9%) were graded 'C,' and 90 (45.5%) ' and 148 (74.7%) graded '2.' There were 3 (1.5%) recommendations graded '1A,' 16 (8.1%) were '1B,' 18 (9.1%) were '1C, ' and 13 (6.6%) were '1D.' There was 1 (0.5%) graded '2A,' 11 (5.6%) were '2B,' 59 (29.8%) were '2C, ' and 77 (38.9%) BackgroundExcept perhaps for transplantation between identical twins, all kidney transplant recipients (KTRs) need immunosuppressive medications to prevent rejection. Induction therapy is treatment with a biologic agent, either a lymphocyte-depleting agent or an interleukin 2 receptor antagonist (IL2-RA), begun before, at the time of, or immediately after transplantation. The purpose of induction therapy is to deplete or modulate T-cell responses at the time of antigen presentation. Induction therapy is intended to improve the efficacy of immunosuppression by reducing acute rejection, or by allowing a reduction of other components of the regimen, such as calcineurin inhibitors (CNIs) or corticosteroids. Available lymphocytedepleting agents include antithymocyte globulin (ATG), antilymphocyte globulin (ALG) and monomurab-CD3. Basiliximab and daclizumab, the two IL2-RAs that are currently available in many parts of the world, bind the CD25 antigen (interleukin-2 [IL2] receptor a-chain) at the surface of activated T-lymphocytes and thereby competitively inhibit IL2-mediated lymphocyte activation, a crucial phase in cellular immune response of allograft rejection. Rationale• There is high-quality evidence that the benefits of IL2-RA vs. no IL2-RA (or placebo) outweigh harm in a broad range of KTRs with variable immunological risk and concomitant immunosuppressive medication regimens.• There is moderate-quality evidence that a lymphocytedepleting agent vs. no lymphocyte-depleting a...

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“…This difference disappears as early as 1 yr after transplantation (19). On the basis of these observations, the conversion from Tac to CyA should be highly considered within a year following transplantation (39, 40). However, later there is no difference between Tac and CyA treatment in terms of incidence of PTDM (41, 42).…”

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confidence: 93%

The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus

et al. 2011

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Solid-organ transplantation is the optimal long-term treatment for most patients with end-stage organ failure. After solid-organ transplantation, short-term graft survival significantly improved (1). However, due to chronic allograft nephropathy and death with functioning graft, long-term survival has not prolonged remarkably (2). Posttransplant immunosuppressive medications consist of one of the calcineurin inhibitors in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroids. All of them have different adverse effects, among which posttransplant diabetes mellitus (PTDM) is an independent risk factor for cardiovascular (CV) events and infections causing the death of many transplant patients and it may directly contribute to graft failure (3). According to the criteria of the American Diabetes Association (4), diabetes mellitus (DM) is defined by symptoms of diabetes (polyuria and polydipsia and weight loss) plus casual plasma glucose concentration ≥ 11.1 mmol/L or fasting plasma glucose (FPG) ≥ 7.0 mmol/L or 2-h plasma glucose level ≥ 11.1 mmol/L following oral glucose tolerance test (OGTT). This metabolic disorder occurring as a complication of organ transplantation has been recognized for many years. PTDM, which is a combination of decreased insulin secretion and increased insulin resistance, develops in 4.9/15.9% of liver transplant patients, in 4.7/11.5% of kidney recipients, and in 15/17.5% of heart and lung transplants [cyclosporine A (CyA)/tacrolimus (Tac)-based regimen, respectively] (5). Risk factors of PTDM can be divided into non-modifiable and modifiable ones (6), among which the most prominent is the immunosuppressive therapy being responsible for 74% of PTDM development (7). Emphasizing the importance of the PTDM, numerous studies have determined the long-term outcome. On the basis of these studies, graft and patient survival is tendentiously (8) or significantly (9, 10) decreased for those developing PTDM.

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Conversion From Tacrolimus to Cyclosporin Is Associated With a Significant Improvement of Glucose Metabolism in Patients With New-Onset Diabetes Mellitus After Renal Transplantation

Cited by 24 publications

References 9 publications

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

Post Transplant Diabetes Mellitus in Ahmed Gasim Kidney Transplant Center, Sudan

Special Issue: KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients

The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus

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