10. New Onset Diabetes Mellitus (NODM) after Tacrolimus
Pancreatic islet damage after treatment for ALL was the subject of a recent abstract in this series, however there is also substantial evidence that the immunosuppressive calcineurin inhibitors, tacrolimus and cyclosporine, have also been implicated when used in the management of transplant patients. In a series covering 1636 and 1407 subjects respectively, tacrolimus was associated with NODM in 10,4% while association of NODM and cyslosporin was seen in 4,5%. Of interest is the observation that Hepatitis C infection independently increases the risk of beta cell damage. There is apparently a well-established epidemiological link between diabetes and Hepatitis C, and in another study insulin resistance, beta cell dysfunction and Hepatitis C were analysed in transplant patients. In 39 Hepatitis C positive and 60 negative liver transplant recipients Hepatitis C and body mass index independently predicted insulin resistance.
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Am J Transplant 2004;583-95
Transplant Proc 2003;36:144-7
Liver Transpl 2004;10:349-55
Transplantation 2004;77:703-10