Posted by Ellen on February 02, 2001 at 14:55:39:
"Posttransplant Diabetes Mellitus In Pediatric Thoracic Organ Recipients Receiving Tacrolimus-Based Immunosuppresssion"
Transplantation
01/31/2001
By Elda Hauschildt
Diabetes mellitus, common among pediatric patients receiving tacrolimus-based immunosuppresion after thoracic transplantation, usually results in insulin-dependence.
University of Pittsburgh School of Medicine researchers report that 17 percent of their pediatric heart and heart-lung/lung patients who survived for 30 days went on to develop diabetes. All of the patients became insulin-dependence.
Insulin dependence was rarely resolved even after both the patients' tacrolimus and steroid dosages were lowered. "Discontinuation of steroids did not guarantee resolution of diabetes," the investigators also note.
Post-transplantation onset of diabetes mellitus is a well-known complication of tacrolimus-based immunosuppresion in both adults and children who receive solid organ transplants.
Researchers reviewed the medical records of 143 pediatric thoracic transplant patients who received tacrolimus-based immunosuppresion.
A total of 24 (17 percent) who survived for 30 days developed diabetes. This included 12 of 96 patients (13 percent) receiving hearts and 12 of 47 heart-lung/lung transplant recipients (26 percent). Seventeen patients demonstrated glucose intolerance before diabetes onset.
Immunosuppresion regimens for 17 of the 24 patients who developed diabetes (71 percent) included maintenance corticosteroids. Researchers found that nine patients (38 percent) developed diabetes during pulsed corticosteroid therapy.
Median time for development of diabetes following transplantation was 9.0 months. Median follow-up was 49.9 months.
"There was a significant decrease in mean tacrolimus dosage, tacrolimus level and steroid dosage from onset of post-transplant diabetes to most recent follow-up," the researchers point out.
"Despite this significant reduction in immunosuppresion, only three of the 24 patients (13 percent) were successfully weaned off insulin."
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Transplantation, 2001; 71: 252-255. "Posttransplant Diabetes Mellitus In Pediatric Thoracic Organ Recipients Receiving Tacrolimus-Based Immunosuppresssion"
POSTTRANSPLANT DIABETES MELLITUS IN PEDIATRIC THORACIC ORGAN RECIPIENTS RECEIVING TACROLIMUS-BASED IMMUNOSUPPRESSION1
Joseph A. Paolillo, Gerard J. Boyle, Yuk M. Law, Susan A. Miller, Kathy Lawrence, Kerstin Wagner, Frank A. Pigula, Bartley P. Griffith, and Steven A. Webber
Departments of Pediatrics and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213
Background. Posttransplantation diabetes mellitus (PTDM) is a well-known complication of tacrolimus-based immunosuppression in both adult and pediatric solid organ recipients. The "natural history" of diabetes in the pediatric thoracic transplant population has not yet been described.
Methods. We identified all pediatric thoracic transplant patients receiving tacrolimus-based immunosuppression who developed PTDM. Medical records were reviewed, with a particular focus on the clinical course of PTDM and its relationship to drug weaning.
Results. Diabetes developed in 24 of 143 (17%) 30-day survivors of heart (12/96, 13%) and heart-lung/lung (12/47, 26%) transplantation. In 17 (71%) patients, the immunosuppressive regimen at the onset of PTDM also included maintenance corticosteroids. Seventeen patients demonstrated glucose intolerance before the onset of diabetes. Nine patients (38%) developed diabetes during pulsed corticosteroid therapy. Median time of onset after transplantation was 9.0 months. All patients required s.c. insulin for glucose control. The median follow-up from transplant was 49.9 months. There was a significant decrease in mean tacrolimus dosage (P<0.01), tacrolimus level (P<0.04), and steroid dosage (P<0.02) from onset of PTDM to most recent follow-up. Despite this significant reduction in immunosuppression, only 3/24 (13%) patients were successfully weaned off insulin.
Conclusions. Diabetes mellitus is a common complication in pediatric thoracic transplant patients receiving tacrolimus-based immunosuppression. Insulin dependence in our population rarely resolved, even after lowering tacrolimus and steroid doses. Discontinuation of steroids did not guarantee resolution of diabetes.