Post‐transplant diabetic ketoacidosis ‐ A possible consequence of immunosuppression with calcineurin inhibiting agents: A case series

• Published in: Transplant international Vol. 13; no. 1; pp. 69 - 72
• Main Authors: Yoshida, Eric M., Buczkowski, Andrzej K., Sirrs, Sandra M., Elliott, Tom G., Scudamore, Charles H., Levin, Adeera, Tildesley, Hugh D., Landsberg, David N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.01.2000
• Subjects: Cyclosporine; Diabetes mellitus; Ketoacidosis; Kidney transplantation; Tacrolimus
• ISSN: 0934-0874; 1432-2277
• DOI: 10.1111/j.1432-2277.2000.tb01039.x

Post‐transplant diabetes mellitus, a complication due to corticosteroids and the calcineurin inhibitors, cyclosporine and tacrolimus (FK506), is commonly regarded as a form of type‐2 (adult‐onset) diabetes mellitus. Diabetic ketoacidosis, which requires relative insulin deficiency to impair fatty acid metabolism, is a complication of type‐1 diabetes mellitus. We report three patients who presented with diabetic ketoacidosis post‐transplant. All three patients presented with severe hyperglycemia, significant ketosis and metabolic acidosis of variable severity. One patient was a renal transplant recipient on a cyclosporine‐based regimen. The other two patients were liver transplant recipients receiving either cyclosporine or tacrolimus‐based immunosuppression. Both of the liver transplant recipients were found to have moderate to high serum levels of calcineurin inhibitors on presentation. The liver recipient on cyclosporine (Neoral) had a 4 hour post‐dose level of 388 ng/ml and the patient on tacrolimus was found to have a trough level of 21.2 ng/ml. Our experience suggests that post‐transplant diabetes mellitus, in association with calcineurin inhibition, may result in ketoacidosis either secondary to relative beta cell dysfunction, peripheral insulin resistance, or a combination of the two effects. Post‐transplant diabetes mellitus can be an atypical form of adult‐onset diabetes with features of both type I and type II diabetes mellitus.