Pediatric Post‐Transplant Diabetes: Data From a Large Cohort of Pediatric Heart‐Transplant Recipients

Abstract

A retrospective analysis of 381 pediatric hearttransplant recipients was performed to determine the frequency, characteristics, and risk factors for post-transplant diabetes. The rate of post-transplant diabetes was 1.8% with antithymocyte globulin, cyclosporine and azathioprine as primary immunosuppressive therapy. Time from transplant to diabetes was 0.25-13 years. Diabetes was characterized by reversibility, and lack of insulinopenia and autoimmunity. The post-transplant diabetes rate in tacrolimusconverted children (n = 45) was 8.8%. In tacrolimusconverted children, age at transplant, mean and maximum tacrolimus blood levels, and first-year rejection episodes were higher in the post-transplant diabetes group, which also consistently had DRmismatched transplants and HLA DR3/DR4 haplotypes. Body mass index was not different between diabetic and control tacrolimus-converted children. In conclusion, pediatric post-transplant diabetes may be related to reversible insulin resistance. Tacrolimus levels, HLA DR mismatch, and older age at transplant may predispose to post-transplant diabetes.

Cardiac allograft vasculopathy after heart transplantation: risk factors and management

“…Of the available studies, most suggest that tacrolimus is the more diabetogenic, although data generally fail to reach significance due to low patient numbers. 26,32,39 For a more detailed discussion of this topic, refer to the study by Marchetti et al (this issue).…”

Adverse Effects of Immunosuppression in Pediatric Solid Organ Transplantation

“…[88] Clinically, tacrolimus increases the risk of PTDM 9-fold, compared with ciclosporin, in children. [89,90] In one study of adult kidney transplant recipients, the adjusted hazards ratio for PTDM in patients receiving sirolimus was 1.6 with both ciclosporin-and tacrolimus-based regimens; [91] this has not yet been demonstrated in children. Other risk factors for PTDM identified in children include first or second degree family history of type 2 diabetes, hyperglycemia within the first 2 weeks of transplantation, [90] and African American race.…”

New-onset diabetes after transplantation

“…In general, a trend toward a slightly higher diabetogenic effect of tacrolimus has been observed, although data have generally failed to reach significance due to low patient numbers (Table 2). [37][38][39][40][41][42] In one study, at 6 months, insulin was administered to 5 of 43 patients (11.6%) receiving tacrolimus vs 3 of 30 (10.0%) in the CsA group; oral anti-hyperglycemic agents were given to a further 5 (11.6%) tacrolimus patients and 2 (6.7%) CsA patients. 38 In another study, the percentage of patients requiring prolonged insulin treatment (Ͼ30 days) at 1 year post-transplant was 7.0% for tacrolimus and 4.3% for CsA.…”