The Effects of Maintenance Doses of Fk506 Versus Cyclosporin a on Glucose and Lipid Metabolism After Orthotopic Liver Transplantation1

Fernández, Luis A.; Lehmann, Roger; Luzi, Livio; Battezzati, Alberto; Angelico, M; Ricordi, Camillo; Tzakis, Andreas G.; Alejandro, Rodolfo

doi:10.1097/00007890-199911270-00017

Cited by 86 publications

(62 citation statements)

References 47 publications

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“…Achieving immune tolerance in islet allograft recipients is an appealing prospect, as it may enable durable function of transplanted islets, without lifelong adverse side effects from immunosuppression. Currently, almost all classical anti-rejection drugs used in the transplant setting (including, calcineurininhibitors, mTOR inhibitors, and steroids) are toxic to islet cells [36][37][38][39][40]. Their continuous use can lead to loss of islet graft function; post-transplant diabetes is a common outcome, even in subjects not prone to diabetes [41].…”

Section: Bone Marrow Stem Cell Transplantation To Induce Hematopoietimentioning

confidence: 99%

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

Fotino

Ricordi²,

Lauriola

et al. 2010

Rev Diabet Stud

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■ AbstractThe bone marrow is an invaluable source of adult pluripotent stem cells, as it gives rise to hematopoietic stem cells, endothelial progenitor cells, and mesenchymal cells, amongst others. The use of bone marrow-derived stem cell (BMSC) transplantation (BMT) may assist in achieving tissue repair and regeneration, and in modulating immune responses in the context of autoimmunity and transplantation. Ongoing clinical trials are evaluating the effects of BMSC to preserve functional beta-cell mass in subjects with type 1 and type 2 diabetes, and to favor engraftment and survival of transplanted islets. Additional trials are evaluating the impact of BMT (i.e., mesenchymal stem cells) on the progression of diabetes complications. This article reviews the progress in the field of BMSC for the treatment of subjects with insulindependent diabetes, by combining allogeneic islet transplantation with donor-specific BMSC. Clinical data is summarized from pilot studies performed at our research center over the last two decades.

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Section: Bone Marrow Stem Cell Transplantation To Induce Hematopoietimentioning

confidence: 99%

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

Fotino

Ricordi²,

Lauriola

et al. 2010

Rev Diabet Stud

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“…In fact, the calcineurin inhibitor cyclosporine has been reported to decrease ␤-cell secretory capacity in pancreas and nondiabetic kidney transplant recipients (22), and tacrolimus has been reported to have a similar effect in liver transplant recipients (38). Thus, generalized ␤-cell dysfunction can mimic a reduced ␤-cell mass and may partially explain the impairments in ␤-cell function and secretory capacity following islet transplantation.…”

Section: ␤-Cell Function After Islet Transplantationmentioning

confidence: 99%

β-Cell Function Following Human Islet Transplantation for Type 1 Diabetes

et al. 2005

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Islet transplantation can provide metabolic stability for patients with type 1 diabetes; however, more than one donor pancreas is usually required to achieve insulin independence. To evaluate possible mechanistic defects underlying impaired graft function, we studied five subjects at 3 months and four subjects at 12 months following intraportal islet transplantation who had received comparable islet equivalents per kilogram (12,601 ؎ 1,732 vs. 14,384 ؎ 2,379, respectively). Cpeptide responses, as measures of ␤-cell function, were significantly impaired in both transplant groups when compared with healthy control subjects (P < 0.05) after intravenous glucose (0.3 g/kg), an orally consumed meal (600 kcal), and intravenous arginine (5 g), with the greatest impairment to intravenous glucose and a greater impairment seen in the 12-month compared with the 3-month transplant group. A glucose-potentiated arginine test, performed only in insulin-independent transplant subjects (n ‫؍‬ 5), demonstrated significant impairments in the glucose-potentiation slope (P < 0.05) and the maximal response to arginine (AR max ; P < 0.05), a measure of ␤-cell secretory capacity. Because AR max provides an estimate of the functional ␤-cell mass, these results suggest that a low engrafted ␤-cell mass may account for the functional defects observed after islet transplantation. Diabetes 54:100 -106, 2005

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“…The other immunosuppressives (azathioprine, mycophenolate mofetil, and sirolimus) are not diabetogenic. The diabetogenic potential of tacrolimus appears to be greater than that of cyclosporine in renal transplant patients, 30 whereas they appear equal in liver transplant recipients, 19,31,32 even though a change from tacrolimus to cyclosporine can completely reverse tacrolimus-induced diabetes in the occasional patient. 33 …”

Section: Prevalence Of Diabetes In Liver Transplant Recipientsmentioning

confidence: 99%

Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

Reuben

2001

Liver Transplantation

115

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Key Points 1. As long-term survival improves after liver transplantation, cardiovascular complications are emerging as a major cause of late morbidity and mortality. It seems reasonable to correct the potentially reversible cardiovascular risk factors of diabetes, hyperlipidemia, and obesity, in addition to hypertension. 2. The results of liver transplantation in diabetics are acceptable in terms of morbidity, mortality, and prevalence of posttransplant diabetes, but the poor outcomes described in some series suggest that more extensive testing for macro-and microvascular disease may become necessary. T he main aim of liver transplantation, besides the immediate goal of saving life, is to return the patient to productive community living with good quality of life. It is ironic, therefore, that many of the health problems that afflict successful liver transplant recipients long term are those of community living in the developed world, including diabetes mellitus, hyperlipidemia, and obesity. These three metabolic derangements, together with hypertension, constitute adverse cardiovascular risk factors for transplant recipients. The management of diabetes in liver transplant recipients is not substantially different from its management in

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The Effects of Maintenance Doses of Fk506 Versus Cyclosporin a on Glucose and Lipid Metabolism After Orthotopic Liver Transplantation1

Abstract: There are no major metabolic differences on low maintenance doses between FK-506 and CsA. Both immunosuppressant agents contribute to the development of PTDM at different levels.

Cited by 86 publications

References 47 publications

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

Bone Marrow-Derived Stem Cell Transplantation for the Treatment of Insulin-Dependent Diabetes

β-Cell Function Following Human Islet Transplantation for Type 1 Diabetes

Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

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