Introduction and Objective: Tacrolimus and steroid can affect insulin secretion and insulin sensitivity, resulting in worsened glucose tolerance after kidney transplant (KTx). However, the effect of these drugs on post-transplant changes in glucose tolerance has not been evaluated in detail. Since HbA1c can be affected by turnover of RBC and use of erythropoietic agents, it's difficult to compare precisely glucose tolerance before and after KTx. We therefore aimed to evaluate the changes in glucose tolerance and to determine the parameters affecting its changes using oral glucose tolerance test (OGTT).

Patients & Methods: Non-diabetic adult kidney transplant recipients (older than 20 y.o.) evaluated by 75g OGTT pre- and 1 year post-transplant were retrospectively analyzed. The patients' glucose tolerance were categorized into three status (normal and impaired glucose tolerance, and diabetic) and their changes 1 year after KTx were evaluated. Clinical characteristics and parameters associated with insulin secretion (i.e. insulinogenic index and Oral disposition index) and insulin sensitivity (i.e. homeostatic model assessment of insulin resistance: HOMA-IR and Matsuda index) were compared in these patients.

Results: Seventy two recipients were included in the current study (age at transplant 42.2±14.4, male patients were 36 cases). All patients were maintained under calcineurin inhibitor-based immunosuppression (tacrolimus in 61 cases and cyclosporine A in 11 cases, respectively). Steroid was withdrawn in 17 cases within 1 year (23.6%). Glucose tolerance improved in 26 cases (36.1%) and got worse in 16 cases (22.2%) and didn't change in 30 cases (41.7%). In comparison between improved group and worsened group, Matsuda index which indicates systemic insulin sensitivity significantly improved 1 year after KTx in improved group (7.88±3.94 vs 3.42±2.22, p<0.0001). However, there was not significant difference in pre-transplant clinical characteristics between these case groups. In addition, usage of tacrolimus or steroid wasn't associated with worsened glucose tolerance.

Conclusions: Systemic insulin sensitivity rather than immunosuppressive drugs is associated with the improvement of glucose tolerance after KTx.

CITATION INFORMATION: Iwami D, Nakamura A, Hotta K, Sasaki H, Hirose T, Higuchi H, Takada Y, Miyoshi H, Shinohara N. Glucose Tolerance After Kideney Transplant Is Affected by Systemic Insulin Sensitivity Rather Than Usage of Tacrolimus. Am J Transplant. 2017;17 (suppl 3).

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