2007 JASN IMPACT FACTOR 7.111	HOME   AUTHOR INFO   EDITORIAL BOARD   SUBSCRIBE   FEEDBACK   ALERTS   HELP
advanced	CURRENT ISSUE	ARCHIVES	JASN Express	ONLINE SUBMISSION

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by DUIJNHOVEN, E. M. V. Articles by HOOFF, J. P. V. Search for Related Content PubMed PubMed Citation Articles by DUIJNHOVEN, E. M. V. Articles by HOOFF, J. P. V.

Influence of Tacrolimus on Glucose Metabolism before and after Renal Transplantation: A Prospective Study

Department of Internal Medicine, University Hospital Maastricht, Maastricht, The Netherlands.

Correspondence to Dr. Elly M. van Duijnhoven, Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Phone: 314-338-77044; Fax: 314-338-75006; E-mail: evd{at}sint.azm.nl

Abstract. Most studies concerning the influence of tacrolimus on glucose metabolism have been performed either in animals or after organ transplantation. These clinical studies have largely been transversal with patients who were using steroids. Therefore, this prospective, longitudinal study investigated the influence of tacrolimus on glucose metabolism before and after transplantation. Eighteen Caucasian dialysis patients underwent an intravenous glucose tolerance test before and 5 d after the start of tacrolimus. Insulin sensitivity index (k_G), insulin resistance (insulin/glucose ratio and homeostasis model assessment), and C-peptide and insulin secretion were calculated. Trough levels of tacrolimus were measured. After transplantation, the occurrence of posttransplantation diabetes mellitus (PTDM) was prospectively monitored. Statistical analysis was performed using the Wilcoxon signed ranks test and Spearman's rho for correlation. Before tacrolimus, k_G was indeterminate in three patients. During tacrolimus, k_G decreased in 16 of 18 patients, from a median of 1.74 mmol/L per min to 1.08 mmol/L per min (P < 0.0001). The correlation between C-peptide and insulin data was excellent. Insulin secretion decreased from 851.0 mU x min/L to 558.0 mU x min/L (P = 0.014), whereas insulin resistance did not change. Insulin sensitivity correlated negatively with tacrolimus trough level. After transplantation, three patients developed PTDM; before tacrolimus, two had an indeterminate and one a low normal k_G. During tacrolimus administration, k_G decreased in almost all patients as a result of a diminished insulin secretion response to a glucose load, whereas insulin resistance did not change. Patients with an abnormal or indeterminate k_G seem to be at risk of developing PTDM while on tacrolimus.

This article has been cited by other articles:

				J. E. Ollech, M. R. Kramer, N. Peled, A. Ollech, A. Amital, B. Medalion, M. Saute, and D. Shitrit Post-transplant diabetes mellitus in lung transplant recipients: incidence and risk factors Eur. J. Cardiothorac. Surg., May 1, 2008; 33(5): 844 - 848. [Abstract] [Full Text] [PDF]

				M. A. C. J. Gelens, M. H. L. Christiaans, and J. P. van Hooff Glucose metabolism before and after conversion from cyclosporine microemulsion to tacrolimus in stable renal recipients Nephrol. Dial. Transplant., February 1, 2008; 23(2): 701 - 706. [Abstract] [Full Text] [PDF]

				J. Hjelmesaeth, L. T. Hagen, A. Asberg, K. Midtvedt, O. Storset, C. E. Halvorsen, L. Morkrid, A. Hartmann, and T. Jenssen The impact of short-term ciclosporin A treatment on insulin secretion and insulin sensitivity in man Nephrol. Dial. Transplant., June 1, 2007; 22(6): 1743 - 1749. [Abstract] [Full Text] [PDF]

				M. F. Crutchlow and R. D. Bloom Transplant-Associated Hyperglycemia: A New Look at an Old Problem Clin. J. Am. Soc. Nephrol., March 1, 2007; 2(2): 343 - 355. [Abstract] [Full Text] [PDF]

				E. Rodrigo, G. Fernandez-Fresnedo, R. Valero, J. C. Ruiz, C. Pinera, R. Palomar, J. Gonzalez-Cotorruelo, C. Gomez-Alamillo, and M. Arias New-Onset Diabetes after Kidney Transplantation: Risk Factors J. Am. Soc. Nephrol., December 1, 2006; 17(12_suppl_3): S291 - S295. [Abstract] [Full Text] [PDF]

				C. J. Rodriguez-Hernandez, I. Sanchez-Perez, R. Gil-Mascarell, A. Rodriguez-Afonso, A. Torres, R. Perona, and J. R. Murguia The Immunosuppressant FK506 Uncovers a Positive Regulatory Cross-talk between the Hog1p and Gcn2p Pathways J. Biol. Chem., September 5, 2003; 278(36): 33887 - 33895. [Abstract] [Full Text] [PDF]

				M. A. Artz, J. M.M. Boots, G. Ligtenberg, J. I. Roodnat, M. H.L. Christiaans, P. F. Vos, H. J. Blom, F. C.G.J. Sweep, P. N.M. Demacker, and L. B. Hilbrands Improved Cardiovascular Risk Profile and Renal Function in Renal Transplant Patients after Randomized Conversion from Cyclosporine to Tacrolimus J. Am. Soc. Nephrol., July 1, 2003; 14(7): 1880 - 1888. [Abstract] [Full Text] [PDF]

				M. E. Doyle and J. M. Egan Pharmacological Agents That Directly Modulate Insulin Secretion Pharmacol. Rev., March 1, 2003; 55(1): 105 - 131. [Abstract] [Full Text] [PDF]

				J. T. Mathew, M. Rao, V. Job, S. Ratnaswamy, and C. K. Jacob Post-transplant hyperglycaemia: a study of risk factors Nephrol. Dial. Transplant., January 1, 2003; 18(1): 164 - 171. [Abstract] [Full Text] [PDF]

				M. Prentki, E. Joly, W. El-Assaad, and R. Roduit Malonyl-CoA Signaling, Lipid Partitioning, and Glucolipotoxicity: Role in {beta}-Cell Adaptation and Failure in the Etiology of Diabetes Diabetes, December 1, 2002; 51(90003): S405 - 413. [Abstract] [Full Text] [PDF]

				E. A. Ryan, J. R.T. Lakey, B. W. Paty, S. Imes, G. S. Korbutt, N. M. Kneteman, D. Bigam, R. V. Rajotte, and A.M. J. Shapiro Successful Islet Transplantation: Continued Insulin Reserve Provides Long-Term Glycemic Control Diabetes, July 1, 2002; 51(7): 2148 - 2157. [Abstract] [Full Text] [PDF]

				R. D. Bloom, V. Rao, F. Weng, R. A. Grossman, D. Cohen, and K. C. Mange Association of Hepatitis C with Posttransplant Diabetes in Renal Transplant Patients on Tacrolimus J. Am. Soc. Nephrol., May 1, 2002; 13(5): 1374 - 1380. [Abstract] [Full Text] [PDF]

				E. M. van Duijnhoven, M. H. L. Christiaans, J. M. M. Boots, F. H. M. Nieman, B. H. R. Wolffenbuttel, and J. P. van Hooff Glucose Metabolism in the First 3 Years after Renal Transplantation in Patients Receiving Tacrolimus versus Cyclosporine-Based Immunosuppression J. Am. Soc. Nephrol., January 1, 2002; 13(1): 213 - 220. [Abstract] [Full Text] [PDF]

				J. M. M. Boots, E. M. van Duijnhoven, M. H. L. Christiaans, B. H. R. Wolffenbuttel, and J. P. van Hooff Glucose Metabolism in Renal Transplant Recipients on Tacrolimus: The Effect of Steroid Withdrawal and Tacrolimus Trough Level Reduction J. Am. Soc. Nephrol., January 1, 2002; 13(1): 221 - 227. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673