Changes in Insulin Sensitivity and Lipid Profile in Renal Transplant Recipients Converted from Cyclosporine or Standard Release Tacrolimus to Once-Daily Prolonged Release Tacrolimus

Joung Wook Yang; Ye Na Kim; Ho Sik Shin; Yeonsoon Jung; Hark Rim

doi:10.4285/jkstn.2017.31.3.126

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Yang, Kim, Shin, Jung, and Rim: Changes in Insulin Sensitivity and Lipid Profile in Renal Transplant Recipients Converted from Cyclosporine or Standard Release Tacrolimus to Once-Daily Prolonged Release Tacrolimus

Original Article

The Journal of the Korean Society for Transplantation 2017; 31(3): 126-132.

Published online: 30 September 2017

DOI: https://doi.org/10.4285/jkstn.2017.31.3.126

Changes in Insulin Sensitivity and Lipid Profile in Renal Transplant Recipients Converted from Cyclosporine or Standard Release Tacrolimus to Once-Daily Prolonged Release Tacrolimus

Joung Wook Yang, M.D., Ye Na Kim, M.D., Ho Sik Shin, M.D., Yeonsoon Jung, M.D., Hark Rim, M.D.

Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea.

Corresponding author: Ho Sik Shin. Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. Tel: 82-51-990-6108, Fax: 82-51-248-5686, 67920@naver.com

Received 10 May 2017 Revised 8 August 2017 Accepted 9 August 2017

The Korean Society for Transplantation

Abstract

Background

Tacrolimus (Tac) can cause impaired insulin release and dyslipidemia, and may affect the development of post-transplant diabetes mellitus. However, these effects on insulin sensitivity and lipid profile have not been compared in renal transplant recipients receiving traditional twice-daily tacrolimus (TacBID) or cyclosporine and those receiving once-daily prolonged release formulation of tacrolimus (TacOD).

Methods

We conducted an observational prospective study of 15 stable non-diabetic renal transplant recipients to observe the changes in insulin sensitivity and lipid profiles for 1 year at a tertiary hospital. We evaluated the levels of hemoglobin A1c, total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides, apolipoprotein A1, apolipoprotein B, serum creatinine, fasting plasma glucose, fasting insulin, homeostatic model assessment of β-cell (HOMA-β) and HOMA-insulin resistance index at baseline and at 2 and 4 months. To analyze differences in parameters, we conducted a Wilcoxon rank sum test and general linear model (GLM)-repeated measures analysis of variance (ANOVA) in both groups (cyclosporine to TacOD conversion group/TacBID to TacOD conversion group).

Results

At baseline, parameters did not differ between groups. GLM-repeated measures ANOVA revealed no change in insulin sensitivity or lipid profile after conversion at baseline or at 2 and 4 months. There were no complications after conversion from standard TacBID or cyclosporine to TacOD.

Conclusions

There was no change in insulin sensitivity or lipid profile in renal transplant recipients. Any conversion from TacBID to TacOD should be performed in a controlled manner under close surveillance.

Keywords: Cyclosporine, Insulin resistance, Kidney transplantation, Tacrolimus

Figures and Tables

Table 1

Evolution of clinical and laboratory data in the cyclosporine group versus the twice daily tacrolimus group at baseline

Data are presented as mean±SD.

Abbreviations: SBP, systolic blood pressure; DBP, diastolic blood pressure; GFR, glomerular filtration rate; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; HbA1c, hemoglobin A1c; HOMA-IR, homeostasis model assessment of insulin resistance.

Table 2

Evolution of laboratory data in the cyclosporine group versus the twice daily tacrolimus group at 4 months

Data are presented as mean±SD.

Abbreviations: LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol.

Table 3

Homeostasis model assessment of insulin resistance before and after conversion of immunosuppressant

Data are presented as mean±SD.

^aP-values by treatment period obtained from linear model using repeated measures analysis of variance (ANOVA); ^bP-values by content obtained from linear model using repeated measures ANOVA.

Table 4

Homeostasis model assessment of β-cell before and after conversion of immunosuppressant

Data are presented as mean±SD.

^aP-values by treatment period obtained from linear model using repeated measures analysis of variance (ANOVA); ^bP-values by content obtained from linear model using repeated measures ANOVA.

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