신 이식 후 당대사에 미치는 Tacrolimus의 영향

Abstract

Purpose: Posttrarisplant diabetes mellitus (PTDM) is one of the feared complications of the immunosuppressive agents following renal transplantation. Despite advances of immunosuppressive therapy, including the introduction of the steroid-sparing calcineurin inhibitors, cyclospoiine and tacrolimus, the incidence rate remains greater than 10~30%. Methods: This prospective study investigated the infiuence of tacrolimus on glucose metabolism before and after transplantation for twenty patients without known glucose metabolism abnormalities. Results: The overall incidence of PTDM was 30% and was developed within 3 months after renal transplantation in majority of cases. During tacrolimus administration, fasting blood glucose increased from a median of 87.0 mg/L to 103.5 mg/dL (P<0.05), and Insulin sensitivity decreased in 15 of 20 patients, from a median of 1.6 mg/dL/min to 1.2 mg/dL/min (P<0.05). Insulin secretion decreased from 1918.3μU X min/mL to 1018.2μU X min/mL (P<0.05), whereas insulin resistance did not change. Conclusion: These results indicate that diminished insulin secretion response to a glucose load rather than insulin resistance was proved as the main pathogenesis of PTDM in renal transplant recipients treated with tacrotimus. Higher tacrolimus trough level, older age, and higher weight were more frequently seen in the PTDM group than normal group, although the difference Med to reach statistical significance. Further prospective studies with a greater number of patients are needed to define the risk factor for PTDM.