BACKGROUND: Cyclosporine (CSA) and tacrolimus (TAC) are the main immunosuppressive agents in heart transplantation. Both CSA and TAC are diabetogenic, however, in clinical practice, TAC is much more so. It is not clear as to whether TAC-induced diabetes leads to more diabetic complications. We sought to compare our transplant patients with the development of diabetic complications in patients treated with TAC – versus CSA-based immunosuppression who developed new onset diabetes after heart transplantation.

METHOD: Between 1994 and 2010, we evaluated 306 heart transplant patients who developed new onset diabetes after heart transplant and divided them into those treated with CSA versus those treated with TAC -based immunosuppression at the time of heart transplantation. 5 year outcomes including survival, transplant vasculopathy, non-fatal major adverse cardiac events, and complications of diabetes including retinopathy, neuropathy, and nephropathy were determined.

RESULTS: Patients treated with TAC developed more complications of diabetes within 5 years after heart transplantation (neuropathy and retinopathy). Average creatinine on TAC was initially lower compared to those treated with CSA immunosuppression. However, in these diabetic patients this benefit is lost at 5 years. However, those patients who had controlled hemoglobin A1C, (<6.5%), had comparable outcome with those patients treated with CSA.

CONCLUSION: TAC -based immunosuppression may have outcome benefit in terms of less rejection; however, long-term complications of diabetes are more prevalent. Therefore, reassessment of the benefit-risk ratio must be evaluated to assess the longer term outcome of TAC -based immunosuppression.

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