Comparative Risk of Impaired Glucose Metabolism Associated with Cyclosporine Versus Tacrolimus in the Late Posttransplant Period

• Published in: American journal of transplantation Vol. 8; no. 9; pp. 1871 - 1877
• Main Authors: Luan, F. L., Zhang, H., Schaubel, D. E., Miles, C. D., Cibrik, D., Norman, S., Ojo, A. O.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.09.2008; Blackwell
• Subjects: Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Biological and medical sciences; Blood Glucose - analysis; Calcineurin inhibitor agents; Cohort Studies; Cyclosporine - immunology; Diabetes Mellitus - epidemiology; Diabetes Mellitus - etiology; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Female; Follow-Up Studies; Glucose - metabolism; Graft Survival; Guidelines as Topic; Humans; Immunosuppressive Agents - immunology; Incidence; kidney transplantation; Kidney Transplantation - immunology; Male; Medical sciences; Middle Aged; new onset diabetes mellitus; Pharmacology. Drug treatments; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Tacrolimus - immunology; Time Factors; Treatment Outcome; United States - epidemiology; United States; Endocrinopathy; Calcineurin inhibitor; Risk; Early stage; Glucose; Homotransplantation; Kidney; Association; Surgery; Graft; Ciclosporin; Protein synthesis inhibitor; Late; new onset diabetes mellitus; Diabetes mellitus; Lactone; Period; Metabolism; Macrolide; Immunomodulator; Treatment; Urinary system; Tacrolimus; Risk factor; Immunosuppressive agent; Pharmacokinetics; Antibacterial agent; Comparative study; Calcineurin inhibitor agents; Kidney transplantation
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/j.1600-6143.2008.02328.x

New onset diabetes after transplantation (NODAT) and impaired fasting glucose (IFG) are common in kidney transplant recipients (KTRs). Calcinuerin inhibitor (CNI) therapy is a causal risk factor. NODAT is associated with increased mortality and diminished graft survival. We studied the incidence of NODAT and IFG in KTRs before and after a medically indicated switch of CNI therapy from cyclosporine (CsA) to tacrolimus (Tac). The study population consisted of 704 nondiabetic KTRs. Of them, 171 underwent conversion from CsA to Tac (group I) and 533 remained on the CsA since transplantation (Group II). Time‐dependent Cox regression and generalized estimating equations were used to account for sequential CNI exposure. NODAT and IFG occurred in 15.2% and 22.1% of group I subjects and 15.6% and 25.8% of group II subjects, respectively (p = 0.90 for NODAT and p = 0.38 for IFG). Accounting for equal follow‐up time since conversion from CsA to Tac, the adjusted 5‐year NODAT‐free survival was 87.4% and 91.4% in group I and group II, respectively (p = 0.90). In conclusion, conversion to Tac, compared to continuous exposure to CsA, carries quantitatively similar risk of impaired glucose metabolism in KTRs in the late posttransplant period. The risk of diabetes following tacrolimus conversion in kidney transplant recipients was similar to the risk of patients continuing to receive cyclosporine.