Carroll, P

Fung, JJ

Jordan, M

McCauley, J

Odocha, O

Scantlebury, V

Shapiro, R

Starzl, TE

Vivas, C

English

PubMed

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Posttranspiant Diabetes Mellitus in African Ame~icans After Renal Transplantation Under FK 506 Immunosuppression o. Odocha. J. McCauley. V. Scantlebury. R. Shapiro. P. Carrotl. M. Jordan. C. Vivas. J.J. Fung. and T.E. Starzt NEW.ONSET diabetes mellitus as a complication fol-lowing transplantation has been prevIOusly reponed by several workers. ,-' However. the role of ethnicity as a factor has not been well defined. panicularly with the newer immunosuppressive agentsK~·D In an attempt to understand the nature of this problem In the African Amencan population. we retrospectively studied a group of African Americans who received renal allografts under FK 506 immunosuppression at the UniversIty of Pitts-burgh Medica! Center between October 26. 1989. and July 24. 1992. PATIENTS AND METHODS The study group consisted oi 41 adult African Americans (27 maies and 14 females) who had undergone renai transplantation <>niy and receIved FK 506 immunosuppression from the time of transplantation. All patients had a minimum postopenlUve fol-low-up of'" weeks. Blood glucose levels obtained preoperatively and during the first I:! weeks posuranspiantatlon were evaluated. Patients were classified as diabetic or nondiabetic as defined by Scantleburv et al.· Immunosuppression was With FK 506 and predmsone. although some patients m addition received azathio-pnne. Stallsllcal analySIS for ooserved differences was done usmg the Fisher E;(act Test. Differences ot P <: .0.5 were conSidered "gJllficant. RESULTS There were tour identifiable groups within the first 11 weeks after transplantauon: group I. normoglycemic pa-lIents: group II. transIent hyperglycemIc. non-insulin-dependent pallents: group III. perststent hyperglycemic. i nsulin·oependent (posttransplant diabetic) patients: and group IV. pretransplant diabetic patients. There were 39% 116 of 41) in group I. 27% (II of 41) in group 11. 20% (8 of 41) in group HI. and 15% (6 of 41) in group IV. Since uiabetes mellitus was already present preoperatively in group I V pauents. they were excluded from lunher anal-VStS an the study. . In companson to the normoglycemlc patients (group fl. pauents who were hvpergiycemtc (groups 1I and lIl) tended to be older: 58% (II of 19) of patlcnts an groups 11 .md III were over 40 years 01 age as opposed to 25% (4 of Ibl of the group i patients (p < .09). In addition. there was :l trend toward more patients undergoing retransplantauon In groups 11 and 1II-3i% (8 of 19). than an group 1-19% 13 of 16) (P <: .(7). No difference was seen 10 the number 01 patients who were hlghty sensitized (PRA > 40%). or an the cumulative steroId dose. DISCUSSION Although the occurrence of diabetes mellitus as a compli-cation following transplantation has been previously de-scribed.'..... the significance of ethnicity. if any. in its frequency of occurrence. has not been clearly estab-lished. ~ Repons of a higher occurrence in African Ameri-cans with no associated increase in morbidity has been reponedK~ but not conrirmed. The finding of 20% occur· rence in our study population is similar to other published series. gK~K~KT All our patients were on FK 506. a new investigational immunosuppressive agent. t>.1 Penubatlon of glucose me-tabolism either by central inhibition of islet ceil insulin secretion or induction of penphera! insulin resistance. or a combination of both. in concen with the known diabeto-genic innuences of steroids have been theorized as possi-ble mechamsms of FK 506 diabetogemcllyK~·U Similar mechanisms have been put forward for cyclosponne as well. It has been our expenence that FK 506-induced diabetes mellitus IS reversible when the steroids and FK 506 dosalZe are reduced. 7 Our observation of an increased inCIdence of hypergly-.;emia in the older population. had been noted by others.:-s and mav be a reriection of the general tendencv for diabetes to occur in the older popUlation. The finding at an increased Inctdence of hyperglycemia in patients receiving more than one allograft. although nO! stausllcally signtri-.;ant. mav be Imponant and walT:lnlS lunher study. In conclusion. although the number of pallents In the study is small. the observed inCIdence or' posttransplant diabetcs mellitus. 20%. appears to be SImilar to that seen In other studies uSlOg a larger and more ethntcally heteroge-neous transplant patient population. Theretore. ethnicity is probably not an Imponant tactor 10 the development of posttransplant diabetes mellitus. REFERENCES t. Starzi TE. Marchloro TL. RiIkind D. et aJ: Surgery 56:.296. 1964 ~K Ruiz JO. Simmons RL. C.lliender CO. et 31: Surgery 73:759. 1~Tg From tne DiviSIOn of Transp,antatJOn. Deoanmenl of Surgery. UmverslIV 01 Pittsburgn. Pittsburgn. PennsylVania. Address reonnl requeSIS 10 O. Odocna. MD. DiVISion 01 Trans· planl8l1011. Depanmenl 01 Surgery. UnIVersity 01 Pinsburgn. Falk Clinic S·C. 3601 Fifth Avenue. Plttsburgn. PA 15213. Q 1993 by AOPlelon & Lange 0041-1345i931S3.00H 0 TrSfISCIBntatJOn ProctHtOIIltJ$. VOl 2S. No. (Augusu. 1993: pp 2433-2434 2433 2434 3. Boudreaux JP. McHugh L. Canaiax MD. et at: TransJ)lan-taUOn 44:376. 1987 4. Sc:antlebury V. Shapiro R. Fung JJ. et at: Transplant Proc: 23:3169. 1991 S. Sumraru NB. Delaney V. Daskalaltis P. et at: Diabetes Care 14:760. 1991 OOOCHA. McCAULEY. SCANTLEBUAY ET AL 6. GOlD T. Kino T. Hatanaka H. ct at: Transplant Proc: 23:2713. 1991 7. Fung JJ. Alcssiani M. Abu-Elmagd K. et at: TransJ)iant Proc 23:310S. 1991 8. Carrou PB. Rilo H. Reyes J. el at: Transplant Proc: 23:3171. 1991 

Posttransplant diabetes mellitus in African Americans after renal transplantation under FK 506 immunosuppression

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Posttransplant diabetes mellitus in African Americans after renal transplantation under FK 506 immunosuppression

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