Post-transplant Diabetes Mellitus in Kidney Transplant Recipients in Sudan: A Comparison Between Tacrolimus and Cyclosporine-Based Immunosuppression

Abstract

Hyperglycemia is a common complication among transplant patients without a history of diabetes mellitus (DM). Although new and potent immunosuppressants have improved short and long-term outcomes after transplantation, these drugs themselves may be associated with a greater risk of hyperglycemia. The present study aimed to determine the prevalence of post-transplant diabetes mellitus (PTDM) in post renal transplant patients in Sudan, and compare the effect of cyclosporine and tacrolimus-based immunosuppressive regimens. All adult kidney transplant recipients without pre-transplant diabetes who attended the transplant clinic at Ahmed Gasim Cardiac Surgery and Renal Transplant Center in Sudan were included. A total of 100 cases with functioning kidney allografts were enrolled in this study. The majority of cases were in the age range between 20 and 60 years (92%). Males and females were nearly equally distributed (56% vs 44%). Fifty-two percent of patients were on cyclosporine and 48% on tacrolimus. Overall, 18% of patients suffered from post-transplant diabetes mellitus. There was no statistically significant difference between tacrolimus and cyclosporine with regards to the prevalence of hyperglycemia (16.6% versus 13.4%; p>0.05).

The effect of tacrolimus-induced toxicity on metabolic profiling in target tissues of mice

“…Post transplanted diabetes is among the most severe Tac-mediated adverse effects [ 19 ]. It is brought on by β-cell apoptosis, diminished insulin gene expression, and direct toxicity to the islets of Langerhans [ 20 ].…”

Development and Validation of a New Score to Assess the Risk of Posttransplantation Diabetes Mellitus in Kidney Transplant Recipients

“…Patients were defined as having new-onset diabetes if they met at least 1 of the following criteria (World Health Organization and American Diabetes Association): (1) fasting blood glucose ≥ 126 mg/dL, (2) random plasma glucose >200 mg/dL, (3) 2-h plasma glucose ≥200 mg/dL during an oral glucose tolerance test, or (4) HbA1c ≥ 6.5%. 4,6,13,20 PTDM status was evaluated 42 d after transplantation (derivation cohort). According to the diagnostic criteria for PTDM, recipients who met the inclusion criteria were divided into 2 groups: PTDM and non-PTDM groups.…”

“…The pathophysiology of PTDM is multifactorial, 2,9,10 involving not only genetic, environmental, and physiological factors that are related to insulin resistance but also impaired insulin secretion because of β-cell damage. 8,11 Multiple modifiable and nonmodifiable risk factors have been implicated in the risk of PTDM, 3,6 such as age, male gender, higher body mass index (BMI), hepatitis C virus infection, hypomagnesemia, genetic susceptibility, reduced physical activity, and unhealthy diet. 3,11 Immunosuppressive therapy used, such as corticosteroids and calcineurin inhibitors, after transplantation may also increase the risk of PTDM.…”

“…8 Several studies have shown that PTDM increases risk of severe infections and early cardiovascular complications after transplantation. 1,6,11 PTDM also increases the risk of graft rejection, graft failure, and mortality because of premature cardiovascular diseases. 2,4,7,9,[11][12][13] A retrospective analysis of the United States Renal Data System, which included >11 000 kidney transplant recipients, showed that PTDM is an independent predictor of mortality and graft failure.…”

“…4,5 The prevalence of PTDM varies (10%–46%) depending on many factors, such as the type of transplant and time points evaluated after transplantation. 2,6 PTDM has been reported to occur in 4% to 25% of renal recipients, 2.5% to 25% of liver transplant recipients, and 4% to 40% of heart transplant recipients. 5,7,8 The risk of developing PTDM is the highest within the first y after transplantation, with a cumulative incidence of 16%.…”