Posttransplantation diabetes mellitus in FK-506-treated renal transplant recipients: Analysis of incidence and risk factors

Background. The development of posttransplantation diabetes mellitus has a major impact on the quality of life and long-term outcome. Methods. One hundred thirty-nine patients without known glucose metabolism abnormalities and treated with FK-506, methylprednisolone, and mycophenolat e mofetil/azathioprine were analyzed for incidence of and risk factors for developing impaired fasting glycemia (IFG) and diabetes mellitus (DM). Results. Using the American Diabetes Association criteria, 15% developed IF G and 32% developed DM in the first year after transplantation. High trough levels of FK-506 during the first month after transplantation (especially > 15 ng/ml) and high body mass index (BMI) were significant risk factors fo r IFG or DM. Patients with (steroid-treated) acute rejections in addition t o high trough levels of FK-506 were most prone to develop DM, whereas high BMI conferred risk of developing EFG. Patients with posttransplantation gly cemic abnormalities also had higher levels of serum triglycerides at the ti me of transplantation, but they needed a lower dose of FK-506 to obtain hig her trough levels of FK-506, suggesting metabolic differences already prese nt before transplantation. The only risk factor retained for persistent IFG or DM beyond the first year was a higher number of trough levels of FK-506 > 15 ng/ml during the first month after transplantation. Conclusions. Induction with an FK-506 based immunosuppressive regimen resul ted in a high incidence of glucose metabolism disorders in renal transplant ation recipients. Higher trough levels of FK-506 during the first month, ac ute rejections, and higher BMI were the most obvious risk factors.