Treatment of tacrolimus-related adverse effects by conversion to cyclosporine in liver transplant recipients

Emre, Sükrü; Genyk, Yuri; Schluger, Leona Kim; Fishbein, Thomas M.; Guy, Stephen R.; Sheiner, Patricia A.; Schwartz, Myron; Miller, Charles M.

doi:10.1007/s001470050012

Cited by 50 publications

(43 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition to the present series, five reports on conversion from tacrolimus to CsA for adverse events in transplant recipients have been published in the literature [9][10][11][12][13]. Four of these have provided data on glucose metabolism which are summarized in Table 4.…”

Section: Literature Reviewmentioning

confidence: 97%

Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature

et al. 2007

View full text Add to dashboard Cite

Section: Literature Reviewmentioning

confidence: 97%

Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature

et al. 2007

View full text Add to dashboard Cite

“…This suggests that patients at high risk may benefit from treatment with CSA, although prospective studies are required to elucidate this. 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

449

286

View full text Add to dashboard Cite

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.

show abstract

“…Data on this issue are scant but, in a study of liver transplant patients with NODAT, reducing the dose of tacrolimus was considered ineffective, whereas a switch to ciclosporin appeared to be more successful. 34 Conversion to mycophenolic acid or a target-of-rapamycin (TOR) inhibitor-based regimen also has the potential for benefit although cumulative experience with sirolimus is more limited than for the immunophilin immunosuppressants. 35 Neither NICE 5 nor the National Service Framework (NSF) for renal services 36 specifically considered the adjustment of immunosuppressive therapy in relation to NODAT.…”

Section: Management Of Nodatmentioning

confidence: 99%

New‐onset diabetes after transplantation

Krentz

Wheeler

2006

Pract Diab Int

View full text Add to dashboard Cite

New-onset diabetes after transplantation (NODAT) is a common and clinically important complication of solid-organ transplantation. Consensus guidelines have recently been published with the aim of increasing awareness of NODAT among the transplant and diabetes communities. Current evidence suggests that the development of posttransplant diabetes has adverse effects on recipient and graft survival. While the pathogenesis of NODAT remains incompletely understood, insulin resistance and insulin deficiency have been identified as key metabolic abnormalities. These defects may be aggravated by certain classes of immunosuppressive drugs, notably corticosteroids and the immunophilins, tacrolimus and ciclosporin. The incidence and prevalence of NODAT, and lesser degrees of glucose intolerance which may also be clinically relevant, were almost certainly underestimated in many early studies. The consensus guidelines call for abandonment of arbitrary diagnostic criteria in favour of current internationally accepted definitions for diabetes and states of glucose intolerance. Recent demographic trends warn of an increasing threat from NODAT: the age of transplant recipients is rising and this population has become more obese. With risk factors for NODAT now identified (older age, obesity, non-white ethnicity, family history of diabetes and hepatitis C infection), it may be possible to reduce the incidence in susceptible individuals listed for transplantation. Lifestyle measures directed at controlling body weight -before and after transplantation -allied to tailored immunosuppressive therapy are recommended. However, since the efficacy and safety of these measures have not been rigorously evaluated in clinical trials, many uncertainties remain. Oral antidiabetic agents and/or insulin treatment are required in a proportion of patients, sometimes temporarily. In addition to the risks of atherothrombotic cardiovascular disease, patients with irreversible NODAT should be considered to be at risk of long-term microvascular complications including retinopathy, foot disease and nephropathy. Further studies are required to ascertain the current incidence, prevalence and natural history of NODAT in order to identify more effective strategies for prevention and management.

show abstract

Treatment of tacrolimus-related adverse effects by conversion to cyclosporine in liver transplant recipients

Cited by 50 publications

References 20 publications

Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature

Conversion from tacrolimus to cyclosporine A for new-onset diabetes after transplantation: a single-centre experience in renal transplanted patients and review of the literature

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

New‐onset diabetes after transplantation

Contact Info

Product

Resources

About