Insulin Requirements After Liver Transplantation and Fk-506 Immunosuppression

Tabasco-Minguillan, J.; Mieles, Luis; Carroll, P. B.; Gavaler, Judith S.; Thiel, David H. Van; Starzl, Thomas E.

doi:10.1097/00007890-199310000-00017

Cited by 47 publications

(23 citation statements)

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“…Furthermore, there are reports that indicate patients who develop NODM while receiving TAC may benefit from conversion to CSA (32,64,65). At least one study also indicates that TAC patients who develop NODM may become normoglycemic without conversion (66).…”

Section: Nodm After Lung Transplantationmentioning

confidence: 99%

New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis

Heisel¹,

Heisel²,

Balshaw³

et al. 2004

American Journal of Transplantation

450

286

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New onset diabetes mellitus (NODM) is a serious complication of transplantation. This meta-analysis evaluates the reported incidence of NODM after solid organ transplantation in patients receiving CNI treatment.Databases from January 1992 to April 2002 were searched. Fifty-six publications providing NODM incidence data were reviewed. Sixteen prospective, randomized comparative studies providing information on incidence of insulin-dependent diabetes mellitus (IDDM) were subjected to meta-analysis.New onset diabetes mellitus was reported in 13.4% of patients after solid organ transplantation, with a higher incidence in patients receiving tacrolimus than cyclosporine (16.6% vs. 9.8%). This trend was observed across renal, liver, heart and lung transplant groups. Meta-analysis of 16 studies included patients receiving either tacrolimus (n = = 1636) or cyclosporine (n = = 1407). The incidence of IDDM was significantly higher among tacrolimus-treated patients (10.4% vs. 4.5%, p < 0.00001), an effect observed in renal (9.8% vs. 2.7% p < 0.00001) and nonrenal (11.1% vs. 6.2%; p < 0.003) groups, and among patients receiving equal doses of concomitant medication in both treatment arms (12.0% vs. 3.0%; p < 0.00001).The reported incidence of NODM during the past decade was significantly higher among patients receiving tacrolimus than cyclosporine. These data provide a quantitative foundation for studies designed to reduce the rates of NODM following solid organ transplantation.

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Section: Nodm After Lung Transplantationmentioning

confidence: 99%

New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis

Heisel¹,

Heisel²,

Balshaw³

et al. 2004

American Journal of Transplantation

450

286

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“…The increased insulin levels may partially compensate for insulin resistance. 10,12 To date, it is unclear whether or not the alterations in glucose metabolism, a feature of cirrhosis, are reversed by LT. A few studies have addressed this problem, [15][16][17] mainly by investigating glucose tolerance after an oral load, while no data are available on insulin sensitivity and the pattern of insulin secretion. Moreover, while glucose metabolism could be improved by the efficiency of the new graft, the immunosuppressive therapy that these patients need to take after LT may impair glucose tolerance.…”

mentioning

confidence: 99%

Glucose intolerance and insulin resistance in cirrhosis are normalized after liver transplantation

et al. 1999

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Cirrhosis is often associated with insulin resistance and glucose intolerance. We evaluated if these alterations are restored by liver transplantation (LT). Glucose tolerance (oral glucose tolerance test [OGTT]), peripheral insulin sensitivity (euglycemic insulin clamp technique), glucose oxidation (indirect calorimetry), nonoxidative glucose disposal, and insulin secretion (hyperglycemic clamp technique) were measured in 6 patients (Group 1) before and 6 months after LT, in 12 patients (Group 2) who underwent LT 6 to 30 months previously, and in 6 healthy individuals (controls). In Group 1, glucose tolerance and insulin sensitivity (3.24 ؎ 0.37 mg/kg/min) were normalized after LT (8.6 ؎ 0.77 mg/kg/min; P F .0001; P ‫؍‬ not significant vs. controls). The improved insulin-mediated glucose uptake was the result of a normalization of nonoxidative glucose disposal. Fasting insulin and C-peptide decreased from 24.6 ؎ 3.3 U/mL and 4.37 ؎ 0.46 ng/dL, respectively, to 12.7 ؎ 1.9 U/mL and 2.46 ؎ 0.5 ng/dL (controls: 10.0 ؎ 3 U/mL and 1.45 ؎ 0.34 ng/dL). The glucoseinduced increase of insulin concentration, which was higher before LT, showed a significant reduction, although the first phase of ␤-cell secretion remained significantly higher compared with that of controls. All these findings were also confirmed in Group 2. The present data indicate that LT normalizes glucose tolerance and insulin sensitivity in cirrhotic patients through an improvement of both hepatic glucose clearance and the peripheral glucose disposal. The latter effect may be the result of the correction of chronic hyperinsulinemia. An increased first-phase ␤-cell insulin secretion in response to high glucose levels persists, suggesting that a memory of previous insulin resistance is maintained. (HEPATOLOGY 1999;30:649-654.)

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“…In liver transplantation, the insulin requirement diminished in tacrolimus-treated patients over time [9,18].…”

Section: Discussionmentioning

confidence: 99%

Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation

Becker

Witzke

Friedrich³

et al. 1997

Transplant Int

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Tacrolimus has been effective both in primary and rescue therapy following steroid and OKT3-resistant acute rejection in liver and kidney transplantation. Due to the effects of tacrolimus on glucose metabolism, there has been concern about its use in simultaneous pancreadkidney transplantation. We report on the results of six patients (three female, three male, age 35.2 k 7.3 years) converted from cyclosporin A to tacrolimus following simultaneous pancreadkidney transplantation in steroid-resistant acute rejection. Tacrolimus was induced 2.8 f 1.7 months (range 1-4.8 months) after transplantation; follow-up was 3-18 months. Following conversion, creatinine levels declined in all patients [3.5 k 1.2 mg/dl before conversion, 3.0 f 1.9 mg/dl ( n = 6) at three months, 1.4 k 0.1 mg/ dl at 1 year ( n = 3)]. Before conversion, fasting blood glucose levels averaged 154 f 33 mg/dl, with three patients receiving insulin. Three months later no patient required insulin, the mean glucose level being 107 i-23 mg/dl ( n = 6); at 1 year it was 92 f 9 mg/dl (n = 3). One patient lost his pancreatic graft after 4 months due to a mycotic aneurysm. We conclude that conversion to tacrolimus is a safe and effective treatment in cases of steroid-resistant rejections following pancreas/ kidney transplantation.

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Insulin Requirements After Liver Transplantation and Fk-506 Immunosuppression

Cited by 47 publications

References 0 publications

New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis

New Onset Diabetes Mellitus in Patients Receiving Calcineurin Inhibitors: A Systematic Review and Meta-Analysis

Glucose intolerance and insulin resistance in cirrhosis are normalized after liver transplantation

Rescue therapy with tacrolimus in simultaneous pancreas/kidney transplantation

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