Influence of Tacrolimus on Glucose Metabolism Before Renal Transplantation.

Duijnhoven, E. van; Christiaans, Maarten H. L.; Nieman, Fred; Wolffenbuttel, Bruce H. R.; Hooff, J van

doi:10.1097/00007890-199904150-01025

Cited by 45 publications

(67 citation statements)

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“…The diabetogenic effect of tacrolimus is dose-related, and the risk of developing diabetes mellitus is highest in the initial period after transplantation when high trough levels are reached (30), whereas at standard maintenance trough levels, no difference between cyclosporine and tacrolimus could be determined with regard to their diabetogenic properties (31). The risk of developing diabetes mellitus after conversion to tacrolimus appears to be restricted to patients who already experience a disturbed glucose tolerance prior to therapy (5,32).…”

Section: Discussionmentioning

confidence: 99%

Conversion from Cyclosporine to Tacrolimus Improves Quality-of-Life Indices, Renal Graft Function and Cardiovascular Risk Profile

Artz¹,

Boots²,

Ligtenberg³

et al. 2004

American Journal of Transplantation

131

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Long-term use of cyclosporine after renal transplantation results in nephrotoxicity and an increased cardiovascular risk profile. Tacrolimus may be more favorable in this respect. In this randomized controlled study in 124 renal transplant patients, the effects of conversion from cyclosporine to tacrolimus on renal function, cardiovascular risk factors, and perceived sideeffects were investigated after a follow-up of 2 years. After conversion from cyclosporine to tacrolimus renal function remained stable, whereas continuation of cyclosporine was accompanied by a rise in serum creatinine from 142 ± 48 lmol/L to 157 ± 62 lmol/L (p < 0.05 comparing both groups). Conversion to tacrolimus resulted in a sustained reduction in systolic and diastolic blood pressure, and a sustained improvement in the serum lipid profile, leading to a reduction in the Framingham risk score from 5.7 ± 4.3 to 4.8 ± 5.3 (p < 0.05). Finally, conversion to tacrolimus resulted in decreased scores for occurrence of and distress due to side-effects. In conclusion, conversion from cyclosporine to tacrolimus in stable renal transplant patients is beneficial with respect to renal function, cardiovascular risk profile, and side-effects. Therefore, for most renal transplant patients tacrolimus will be the drug of choice when long-term treatment with a calcineurin inhibitor is indicated.

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Section: Discussionmentioning

confidence: 99%

Conversion from Cyclosporine to Tacrolimus Improves Quality-of-Life Indices, Renal Graft Function and Cardiovascular Risk Profile

Artz¹,

Boots²,

Ligtenberg³

et al. 2004

American Journal of Transplantation

131

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“…This index was inversely correlated with the tacrolimus trough level. No patients with tacrolimus trough levels Ͻ15 ng/ml showed an abnormal index (31). A 33% tacrolimus level reduction resulted in a 36% improvement in pancreatic ␤ cell secretion capacity (25).…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

New-Onset Diabetes after Kidney Transplantation

Rodrigo

Fernández‐Fresnedo

Valero

et al. 2006

Journal of the American Society of Nephrology

155

107

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New-onset diabetes after transplantation (NODAT) contributes to the risk for cardiovascular disease and infection, reducing graft and patient survival. For improvement of the outcome of kidney transplant recipients, it is of great interest to know precisely the risk factors that contribute to NODAT development. Nonmodifiable risk factors for development of NODAT are age, race, genetic background, family history of diabetes, and previous glucose intolerance. Modifiable risk factors are obesity and overweight, hepatitis C virus and cytomegalovirus infections, and immunosuppressive drugs. Both steroids and calcineurin inhibitors influence the appearance of NODAT, whereas the role of sirolimus in glucose metabolism currently is controversial.

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“…Buttressing these studies are several reports that examined the impact of CNIs on glucose metabolism. These investigations indicated that CNIs depress glucose-stimulated insulin secretion within days of exposure (76), that lowering CNI trough concentrations can result in an increased insulin secretory response to glucose (77,78), and that tacrolimus seems to have a more marked effect on insulin secretion than CsA (79). Together, these studies confirm that CNIs promote TAH and implicate impaired insulin secretion as the cause.…”

Section: Immunosuppression and Tahmentioning

confidence: 99%

Transplant-Associated Hyperglycemia

Crutchlow¹,

Bloom²

2007

Clinical Journal of the American Society of Nephrology

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New-onset diabetes has long been recognized as a common complication of kidney transplantation, promoting cardiovascular disease, death, and graft failure. Studies in recent years have begun to highlight the very high posttransplantation prevalence of the prediabetic states of impaired fasting glucose and impaired glucose tolerance and the significant repercussions of these states on cardiovascular health. Therefore, the overall burden of transplant-associated hyperglycemia (TAH), which encompasses new-onset diabetes and the prediabetic states, is far greater than previously appreciated. The kidney transplant population is predisposed to insulin resistance and to additional insults of hypertension and hyperlipidemia that, together with hyperglycemia, compose the metabolic syndrome and promote atherosclerosis. When recipients with an underlying, frequently nonmodifiable predisposition to glucose dysregulation encounter transplant-specific, often modifiable, diabetogenic exposures, TAH manifests. Aggressive screening will effectively detect TAH, whereas risk factor modification, lifestyle intervention, and, when appropriate, drug therapy may decrease its impact. Topics of future investigation should include the use of emerging diabetes therapies and avenues for the prevention and reversal of TAH.

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Influence of Tacrolimus on Glucose Metabolism Before Renal Transplantation.

Cited by 45 publications

References 0 publications

Conversion from Cyclosporine to Tacrolimus Improves Quality-of-Life Indices, Renal Graft Function and Cardiovascular Risk Profile

Conversion from Cyclosporine to Tacrolimus Improves Quality-of-Life Indices, Renal Graft Function and Cardiovascular Risk Profile

New-Onset Diabetes after Kidney Transplantation

Transplant-Associated Hyperglycemia

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