COMPLICATIONS - METABOLIC

M.W.F. Van den hoogen, A.M. Van der hoeven, L.B. Hilbrands
Department Of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands, Nijmegen/NETHERLANDS

Body: Introduction. Patients with pre-existing diabetes mellitus (DM) type 2 who are not treated with insulin at the time of transplantation are at high risk of requiring insulin treatment after transplantation. Treatment with insulin is more cumbersome than the use of oral antidiabetic drugs, and requires more intensive control of blood glucose levels. While several immunosuppressive drugs have an adverse effect on glucose metabolism, cyclosporine appears to be less diabetogenic than tacrolimus. We performed a study to assess the potential of the use of cyclosporine instead of tacrolimus as primary immunosuppressant to prevent the start of insulin treatment in patients with pre-existent DM type 2. Methods: Adult renal transplant patients with pre-existing DM type 2, not treated with insulin, were treated with cyclosporine in combination with mycophenolate mofetil, and corticosteroids, instead of our usual regimen consisting of tacrolimus, mycophenolate mofetil, and steroids. Our study design did not include a control group of tacrolimus treated patients because of the small number of patients that was expected to meet the entry criteria. Results: Between January 2000 and December 2008, 846 adults underwent a renal transplantation in our centre. We identified thirteen patients (eight males and five females) with pre-existent DM type 2 that were not using insulin at the time of transplantation. The baseline characteristics of the patients are shown in Table 1. Six patients were treated with oral antidiabetic drugs at the time of transplantation. The average age was 60.3±6.5 years, and average BMI at the time of transplantation was 26.8±3.7 kg/m2. None of the patients had positive hepatitis C serology. During follow-up, ten of thirteen patients required treatment with insulin, eight of them within two months after transplantation (see Figure 1). All patients, in whom insulin treatment was started, were still using insulin at the end of follow-up. Six patients were treated with methylprednisolone or anti-T-cell therapy for acute rejection. None of the baseline characteristics could sufficiently predict the risk of needing insulin treatment. Conclusion: In the majority of patients with pre-existing DM type 2 not treated with insulin pre-transplantation, the use of cyclosporine instead of tacrolimus cannot prevent the start of insulin treatment post-transplantation. Probably, other factors (like concomitant use of steroids) more strongly determined the post-transplant need for insulin. Based on these facts and our disappointing results, we conclude that the use of cyclosporine instead of tacrolimus in patients with pre-existing DM type 2 in order to prevent the post-transplant start of insulin treatment cannot be recommended.

Disclosure: All authors have declared no conflicts of interest.