Carlos Vivas

Carroll

Demetrius Ellis

Filler

Furth

John J. Fung

Mark L. Jordan

Miller

Moxey-Mimms

Ochiai

Pirsch

Richard L. Simmons

Ron Shapiro

Scantlebury

Shapiro

Susan Lombardozzi-Lane

Thomas E. Starzl

Uchida

Velma Scantlebury

English

Crossref

POSTTRANSPLANT DIABETES IN PEDIATRIC RECIPIENTS ON TACROLIMUS

Shapiro, R

Scantlebury, V

Jordan, ML

Vivas, C

Ellis, D

Lombardozzi- Lane, S

Fung, JJ

Simmons, RL

Starzl, TE

D-Scholarship@Pitt

F -----------------_._--", 0041-1337/99/6705-77110 TRANSPLANTATION Copyright © 1999 by Lippincott Wilhams & Wilkins, Inc. ~~p~ Vol. 67, 771, No.5, March 15. 1999 Pr.nted in U.S.A Transplantation® LEITER TO THE EDITOR POSTIRANSPLANT DIABETES IN PEDIATRIC RECIPIENTS ON TACROLIMUS We read with interest the report by Moxey-Mims et aI., "Increased Incidence of Insulin-Dependent Diabetes Mellitus in Pediatric Renal Transplant Patients Receiving Tacrolimus (FK506)," reporting a 100% incidence of posttransplant dia-betes mellitus in five pediatric patients receiving tacrolimus-based immunosuppression after renal transplantation (1). Although posttransplant diabetes mellitus (PTDM) has been a commonly observed complication in adult patients receiv-ing tacrolimus, with an initial incidence of 6.0-28.3% and a final incidence of2.5-12.8% (2-9), it has been less common in pediatric patients, and has tended to be reversible in the overwhelming majority ofthe cases (10-13). The incidence of 100% reported by the authors is substantially at variance with the incidence that we and others have seen; of perhaps greater concern is the seeming lack of reversibility in most of the patients, If we are to infer from their article, three of the five children are still on insulin. Our speculation, to be frank, is that these patients are being chronically overimmunosuppressed. Steroid with-drawal has been possible in some two thirds of pediatric recipients (11), and, in patients not withdrawn from steroids, relatively low dosages can be achieved relatively soon after transplantation. In addition, the target tacrolimus levels de-scribed by the authors are high, although the actual figures described in the patients in question are not excessively out of range. It has been our experience, and that of others, that PTDM is largely reversible with appropriate reduction in the dos-ages of both tacrolimus and prednisone. It would be interest-ing to see what would happen to the patients described in this article if an attempt was made to decrease the dosages of both tacrolimus and steroids. RON SHAPIROI ,5 VELMA SCANTLEBURyI MARK L. JORDAN2 CARLOS VIV AS2 DEMETRIUS ELLIS3 SUSAN LOMBARDOZZI-LANE3 JOHN J_ FUNGI RICHARD L. SIMMONS4 THOMAS E. STARZL 1 Division of Transplantation Thomas E. Starzl Transplantation Institute Division of Urology Division of Pediatric Nephrology Dept. of Surgery University of Pittsburgh Medical Center Pittsburgh, Pennsylvania 1 Division of Transplantation, Thomas E. Starzl Transplantation Institute. 2 Division of Urology. 3 Division of Pediatric Nephrology. 4 Dept. of Surgery. 5 Address correspondence to: Ron Shapiro, M.D., Assoc. Prof. of Surgery, Director, Renal Transplantation, Thomas E. Starz! Trans-plantation Institute, University of Pittsburgh, Department of Sur-gery, 4C Falk Clinic, 3601 Fifth Avenue, Pittsburgh, PA 15213. REFERENCES 1. Moxey-Mimms MM, Kay C, Light JA, Kher KK. Increased inci-dence of insulin-dependent diabetes mellitus in pediatric renal transplant patients receiving tacrolimus (FK5061. Transplan-tation 1998; 65(5): 617. 2. Shapiro R, Scantlebury VP, Jordan ML, et al. Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature. Trans Proc 1997; 29(6): 2737. 3. Scantlebury V, Shapiro R, Fung JJ, et al. New onset of diabetes in FK506 vs. cyclosporine-treated kidney transplant recipi-ents. Trans Proc 1991; 23: 3169. 4. Shapiro R, Jordan ML, Scantlebury VP, et al. A prospective, randomized trial of FK506/prednisone vs. FK506/azathioprinei prednisone in renal transplant patients. Trans Proc 1995; 27(1): 814. 5. Uchida K, Katashi F, Ochiai T, et al. Long-term FK506 (tacroli-mus) therapy in kidney transplantation. Jpn J Transplant 1995; 29(6): 632. 6. Ochiai T, Fukao K, Takahashi K, et al. A phase III comparative study of FK506 (tacrolimus) on kidney transplantation: com-parison with ciclosporin based immunosuppressant regimen. Jpn J Transplant 1995; 29(6): 650. 7. Pirsch JD, Miller J, Deierhoi MR, et al. A comparison oftacrolirnus (FK506) and cyclosporine for immunosuppression after cadaveric renal transplantation. Transplantation 1997; 63: 977. 8. Miller J, Pirsch JD, Deierhoi R. FK506 in kidney transplanta-tion: results of the U.S.A. Randomized Comparative Phase III Study. Trans Proc 1997; 29: 304. 9. Mayer AD, Dmitrewski J, Squiffiet, et al. Multicenter random-ized trial comparing tacrolimus (FK506) and cyclosporine in the prevention of renal allograft rejection: a report of the European Tacrolimus Multicenter Renal Study Group. Trans-plantation 1997; 64(3): 436. 10. Carroll PB, Rilo H, Reyes J, et al. FK-506 associated diabetes mellitus in the pediatric transplant population is a rare com-plication. Transplant Proc 1991; 23: 3171. 11. Shapiro R, Scantlebury VP, Jordan ML, et al. Tacrolimus in pediatric renal transplantation. Transplantation 1996; 62(12): 1752. 12. Filler G, Amendt P, Von Bredow MA, Ehrich JH. Transient diabetes mellitus and peripheral insulin resistance following tacrolimus intoxication in a child after renal transplantation. Nephrol Dial Trans 1997; 12(2): 334. 13. Furth S, Neu A, Colombani P, Plotnick L, Turner ME, Fivush B. Diabetes as a complication of tacrolimus (FK506) in pediatric renal transplant patients. Pediatr Nephrol 1996; 10(1): 64. 771 2 US _U!d)iUIQM i.£UJtREkk& M 'ODnL;&! 2 j 

Posttransplant diabetes in pediatric recipients on Tacrolimus

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Posttransplant diabetes in pediatric recipients on Tacrolimus

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