Introduction and Objective: Tacrolimus and steroid are considered to affect insulin secretion and insulin sensitivity, respectively, resulting in worse glucose tolerance after pediatric kidney transplant (KTx). However, the effect of these drugs on post-transplant glucose tolerance has not been evaluated in detail. We therefore aimed to evaluate the frequency of impairment of glucose tolerance and to determine the parameters affecting glucose tolerance using oral glucose tolerance test (OGTT).

Patients & Methods: Non-diabetic pediatric kidney transplant recipients (younger than 16 y.o. at transplant) evaluated by OGTT post-transplant were retrospectively analyzed. Among them, frequency of impaired glucose tolerance was evaluated and the patients were divided into 2 groups, normal (NGT) group and impaired or diabetic (IGT/DM) group. Clinical characteristics, cumulative dose of immunosuprressive drugs, and insulin secretion and sensitivity calculated by OGTT were compared between the groups.

Results: Twenty three recipients were included in the current study (age at transplant and at OGTT evaluation 9.4±4.6 and 17.6±5.2, respectively). All patients were maintained under calcineurin inhibitors-based immunosuppression (tacrolimus in 22 cases and cyclosporine A in 1, respectively). Steroid was withdrawn in 14 cases (60.8%) at OGTT evaluation. Impairment of glucose tolerance (IGT/DM) was observed in 6 cases (26.0%). There was no significant difference in clinical characteristics (age or body mass index at transplant, age at OGTT, gender, graft function, dialysis period, dosage of tacrolimus, current usage or cumulative dose of steroid). In IGT/DM group, body mass index was significantly higher than in NGT group (24.4±3.9 and 19.1±2.7, respectively, p=0.0013). There was no significant difference in insulin secretion between the groups. In contrast, Matsuda index indicating systemic insulin sensitivity was significantly lower (3.80±1.35 vs 6.08±2.73, p=0.011) in IGT/DM group.

Conclusions: Systemic insulin sensitivity associated with post-transplant overweight rather than immunosuppressive drugs is associated with the impairment of glucose tolerance in pediatric KTx.

CITATION INFORMATION: Iwami D, Hotta K, Sasaki H, Hirose T, Higuchi H, Takada Y, Shinohara N. Impairment of Glucose Tolerance After Pediatric Kidney Transplant Is Associated with Worse Systemic Insulin Sensitivity Rather Than Fall in Insulin Secretion. Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress