The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus

A. Prokai, A. Fekete, K. Pasti, K. Rusai, N. F. Banki, G. Reusz, A. J. Szabo

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Solid-organ transplantation is the optimal long-term treatment for most patients with end-stage organ failure. After solid-organ transplantation, short-term graft survival significantly improved (1). However, due to chronic allograft nephropathy and death with functioning graft, long-term survival has not prolonged remarkably (2). Posttransplant immunosuppressive medications consist of one of the calcineurin inhibitors in combination with mycophenolate mofetil (MMF) or azathioprine (Aza) and steroids. All of them have different adverse effects, among which posttransplant diabetes mellitus (PTDM) is an independent risk factor for cardiovascular (CV) events and infections causing the death of many transplant patients and it may directly contribute to graft failure (3). According to the criteria of the American Diabetes Association (4), diabetes mellitus (DM) is defined by symptoms of diabetes (polyuria and polydipsia and weight loss) plus casual plasma glucose concentration ≥11.1 mmol/L or fasting plasma glucose (FPG) ≥7.0 mmol/L or 2-h plasma glucose level ≥11.1 mmol/L following oral glucose tolerance test (OGTT). This metabolic disorder occurring as a complication of organ transplantation has been recognized for many years. PTDM, which is a combination of decreased insulin secretion and increased insulin resistance, develops in 4.9/15.9% of liver transplant patients, in 4.7/11.5% of kidney recipients, and in 15/17.5% of heart and lung transplants [cyclosporine A (CyA)/tacrolimus (Tac)-based regimen, respectively] (5). Risk factors of PTDM can be divided into non-modifiable and modifiable ones (6), among which the most prominent is the immunosuppressive therapy being responsible for 74% of PTDM development (7). Emphasizing the importance of the PTDM, numerous studies have determined the long-term outcome. On the basis of these studies, graft and patient survival is tendentiously (8) or significantly (9, 10) decreased for those developing PTDM.

Original languageEnglish
Pages (from-to)81-91
Number of pages11
JournalPediatric Diabetes
Volume13
Issue number1
DOIs
Publication statusPublished - Feb 2012

Fingerprint

Immunosuppressive Agents
Diabetes Mellitus
Transplants
Organ Transplantation
Graft Survival
Glucose
Cardiovascular Infections
Mycophenolic Acid
Polydipsia
Polyuria
Azathioprine
Tacrolimus
Glucose Tolerance Test
Cyclosporine
Allografts
Insulin Resistance
Weight Loss
Fasting
Steroids
Insulin

Keywords

  • Aza
  • CAMP
  • CV
  • CyA
  • DM
  • FKBP
  • FPG
  • HNF
  • HOMA-R
  • IFG
  • IGT
  • IL
  • Immunosuppressants
  • IMPDH
  • MMF
  • MODY
  • MTOR
  • NFATc
  • OGTT
  • PTDM
  • Sir
  • Tac
  • Transplantation

ASJC Scopus subject areas

  • Internal Medicine
  • Pediatrics, Perinatology, and Child Health
  • Endocrinology, Diabetes and Metabolism

Cite this

The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus. / Prokai, A.; Fekete, A.; Pasti, K.; Rusai, K.; Banki, N. F.; Reusz, G.; Szabo, A. J.

In: Pediatric Diabetes, Vol. 13, No. 1, 02.2012, p. 81-91.

Research output: Contribution to journalArticle

Prokai, A. ; Fekete, A. ; Pasti, K. ; Rusai, K. ; Banki, N. F. ; Reusz, G. ; Szabo, A. J. / The importance of different immunosuppressive regimens in the development of posttransplant diabetes mellitus. In: Pediatric Diabetes. 2012 ; Vol. 13, No. 1. pp. 81-91.
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