Conversion from tacrolimus to neoral for postrenal transplant diabetes

Diabetes mellitus (DM) is a well-recognized complication of immunosuppressi ve therapy in the post-transplant (Tx) period. The DM encountered in the se tting of tacrolimus therapy has been managed in the past by tacrolimus dose reduction and a rapid corticosteroid taper; frequently insulin therapy is also required to maintain normoglycemia. However, the dose reduction of imm unosuppressive agents has often resulted in acute allograft rejection. We a re reporting our experience in managing three pediatric renal Tx recipients who developed DM in the post-Tx period while on triple immunosuppressive t herapy including tacrolimus and corticosteroids. All of our patients were m anaged by substitution of tacrolimus with conventional doses of neoral whil e maintaining their usual corticosteroid dose. All three patients had resol ution of hyperglycemia and none experienced acute rejection. Tacrolimus was then successfully reinitiated 4.6 months later; at last follow-up, all of our patients have good allograft function and have maintained a normal bloo d sugar. In conclusion, we feel that conversion of patients from tacrolimus to neoral should be attempted as a safer alternative to tacrolimus dose re duction, for managing post-Tx DM in tacrolimus treated patients.