NEW-ONSET DIABETES-MELLITUS IN PEDIATRIC THORACIC ORGAN RECIPIENTS RECEIVING TACROLIMUS-BASED IMMUNOSUPPRESSION

Background: Tacrolimus has a negative effect on the pancreatic beta is let cell, and both glucose intolerance and diabetes mellitus are well- recognized complications of tacrolimus-based immunosuppression among a dult solid organ transplant recipients. Methods: To determine the asso ciation between tacrolimus and new-onset diabetes mellitus in childhoo d, we reviewed data on 78 pediatric heart and heart-lung/lung recipien ts receiving tacrolimus-based immunosuppression. Trough tacrolimus lev els, fasting and random blood glucose levels, and corticosteroid requi rements were reviewed. Diabetes was defined as glucose intolerance req uiring long-term insulin treatment more than 30 days after transplanta tion. Results: No patient had diabetes before introduction of tacrolim us. In heart-lung/lung recipients, 12 of 28 (43%) had development of d iabetes at a median follow-up of 7 months (range 1 to 39). In this gro up diabetes developed in three of eight (38%) patients with cystic fib rosis and nine of 20 (45%) without (p = NS). In contrast, only two of 50 (4%) heart transplant recipients had development of diabetes. Of th e 14 patients with diabetes, 10 had development of diabetes during aug mentation of immunosuppression with pulsed corticosteroids. Tacrolimus trough levels were significantly lower in heart compared with heart-l ung/lung transplant recipients (9.4 +/- 3.3 versus 15.3 +/- 0.9 ng/ml) (p < 0.01), and at latest follow-up significantly fewer heart transpl ant recipients,were treated with maintenance corticosteroids (28% vers us 75%; p < 0.01). In the heart-lung/lung group, no significant differ ence in tacrolimus levels was found between patients with and without diabetes, nor was there a significant difference in the average cortic osteroid dose or number of pulses of corticosteroids per patient. Conc lusions: New-onset diabetes mellitus is rare in pediatric heart transp lant recipients receiving tacrolimus-based immunosuppression, but it o ccurs with a high incidence after pediatric heart-lung/lung transplant ation and usually develops during pulsed corticosteroid therapy. Howev er, it is currently not possible to predict which heart-lung/lung tran splant recipients will have development of this serious complication.