COMPLETE REVERSAL OF FK-506 INDUCED DIABETES IN A LIVER-TRANSPLANT RECIPIENT BY CHANGE OF IMMUNOSUPPRESSION TO CYCLOSPORINE-A

We report the case of a 41-year old patient who underwent orthotopic l iver transplantation because of decompensated liver cirrhosis due to c hronic HCV-infection. Severe acute allograft rejection was insufficien tly controlled by cyclosporine A, steroids and a 6-day regimen of OKT 3 monoclonal antibody therapy. As a consequence immunosuppressive ther apy was switched to FK 506 in a dose of 3 mg bid. The FK 506 concentra tion in whole blood consistently ranged between 5.1 and 7.8 ng/ml. Sev en weeks after the onset of FK 506 therapy the patient developed sever e diabetes mellitus with fasting blood glucose levels up to 640 mmol/l . The C-peptide was elevated reflecting a higher than normal insulin s ecretion. Intravenous insulin therapy with application of up to 85 uni ts regular insulin per day was initiated. Because of the severe diabet es immunosuppression was changed back to cyclosporine A. After six wee ks the patient did no longer require insulin and showed an entirely no rmal glucose tolerance test, C-peptide and Hb A1-level. This case show s that the diabetogenic side effect of FK 506 is more pronounced than that of cyclosporine A. We propose to change immunosuppressive therapy to cyclosporine A in cases of FK 506 induced severe diabetes mellitus , since long-term prognosis of many transplant recipients may depend o n side effects of the immunosuppressive agents.