Em. Yoshida et al., Post-transplant diabetic ketoacidosis - A possible consequence of immunosuppression with calcineurin inhibiting agents: A case series, TRANSPLAN I, 13(1), 2000, pp. 69-72
Post-transplant diabetes mellitus, a complication due to corticosteroids an
d the calcineurin inhibitors, cyclosporine and tacrolimus (FK506), is commo
nly regarded as a form of type-2 (adult-onset) diabetes mellitus. Diabetic
ketoacidosis, which requires relative insulin deficiency to impair fatty ac
id metabolism, is a complication of type-1 diabetes mellitus. We report thr
ee patients who presented with diabetic ketoacidosis post-transplant. All t
hree patients presented with severe hyperglycemia, significant ketosis and
metabolic acidosis of variable severity. One patient was a renal transplant
recipient on a cyclosporine-based regimen. The other two patients were liv
er transplant recipients receiving either cyclosporine or tacrolimus-based
immunosuppression. Both of the liver transplant recipients were found to ha
ve moderate to high serum levels of calcineurin inhibitors on presentation.
The liver recipient on cyclosporine (Ne-oral) had a 4 hour post-dose level
of 388 ng/ml and the patient on tacrolimus was found to have a trough leve
l of 21.2 ng/ml. Our experience suggests that post-transplant diabetes mell
itus, in association with calcineurin inhibition, may result in ketoacidosi
s either secondary to relative beta cell dysfunction, peripheral insulin re
sistance, or a combination of the two effects. Post-transplant diabetes mel
litus can be an atypical form of adult-onset diabetes with features of both
type I and type II diabetes mellitus.