N. Goto

Diabetes mellitus after transplant: relationship to pretransplant glucose metabolism and tacrolimus or cyclosporine A-based therapy.

Objective. The purpose of this study was to identify pretransplantation and posttransplantation indicators for the development of diabetes mellitus in the first 2 months after renal transplantation and to examine the influence of a cyclosporine A (CsA)-based versus a tacrolimus-based immunosuppressive regimen on these risk factors. Methods. Key variables associated with the development of posttransplant diabetes mellitus (PTDM) in the first 2 months after transplantation were assessed in 48 patients who underwent living-related renal transplantation and who were treated with a CsA-based or a tacrolimus-based immunosuppressive regimen. The insulinogenic index (I Index) and glucose infusion rate (GIR) were measures of insulin secretion and insulin sensitivity, respectively. Results. Eight patients developed PTDM. I Index (odds ratio, 0.000384) and GIR (odds ratio, 0.349) were significant risk factors for PTDM development. The cumulative steroid dose had a borderline association. PTDM developed in 4 of 28 CsA-treated patients and in 4 of 20 tacrolimus-treated patients. CsA therapy increased the mean I Index from 0.713±0.071 preoperatively to 1.130±0.140 postoperatively (P <0.01), whereas in tacrolimus-treated patients, I Index remained unchanged (1.09±0.264 preoperatively and 0.949±0.296 postoperatively; P =not significant). Age, duration of pretransplant dialysis, and body mass index did not predict PTDM development. All eight patients with PTDM had hypertension. Conclusions. Pre- and posttransplant abnormalities of insulin secretion and sensitivity are significant predictors of PTDM. Corticosteroid cumulative dose may affect the incidence of PTDM during the first 2 months after transplantation. CsA treatment increases insulin secretion in patients with a high pretransplant risk of PTDM.

Calciphylaxis: A Rare Complication of Patients Who Required Parathyroidectomy for Advanced Renal Hyperparathyroidism

Calciphylaxis is a relatively rare but life-threatening complication in uremic patients. Clinical findings and prognosis were evaluated in six patients who developed calciphylaxis from a group of 1499 patients who underwent parathyroidectomy (PTx) for advanced renal hyperparathyroidism (HPT) in our department from July 1972 to July 2003. The frequency of calciphylaxis was 0.40% (6/1499). Two patients were women and four were men. The mean age was 50.5 years, and the mean duration of hemodialysis (HD) treatment was 14.0 years. In five of six patients, calciphylaxis was classified as distal type; in one case, as proximal type. In three patients, calciphylaxis was diagnosed at the time for PTx. In two patients, calciphylaxis was identified after PTx, although the serum parathyroid hormone (PTH) level was within the appropriate range for dialysis patients. In two patients, calciphylaxis improved after PTx, but two patients required leg and toe amputations after PTx. In one patient with the proximal type of calciphylaxis, the condition occurred when a high PTH level recurred after the initial PTx. The patient died as a result of a serious infection due to uncontrollable skin ulcers. Calciphylaxis is a rare complication in patients who require PTx for renal HPT. Especially the proximal type has a poor prognosis. High levels of the Ca × P product and/or PTH are risk factors. Therefore, this syndrome should be kept in mind and attention should be paid to reduce risk factors. It is important that PTx being performed at the right time in patients with advanced renal HPT refractory to medical treatment.

IMPACT OF TIMING OF MEAL INTAKES ON THE THERAPEUTIC DRUG MONITORING OF CYCLOSPORINE-MICROEMULSION ADMINISTRATION IN STABLE RENAL TRANSPLANT RECIPIENTS - IS C2 LEVELS MANAGEMENT THE OPTIMAL MONITORING METHOD IN STABLE RENAL TRANSPLANT PATIENTS?: 950

Mycophenolate (MMF/MPS) – associated diarrea is common, and may hypotetically interfere with Cyclosporin A (CyA) absorbtion. To assess this in a group of patients on a triple-drug immunosuppressive regimen (CyA, MMF or MPS, and steroids). CyA blood levels 2 hours post oral intake (C-2, were measured in 20 patients suffering this type of diarrhea, and in a control group (n=21) without diarrhea. C-2 levels dropped signifi cantly in 75% of patients with diarrhea (n=15). but only in 38% (n=8) of the control group (p=0.039). We conclude, that in the given setting, where CyA is frequently used in association with MMF or MPS, C-2 levels must be watched closely if patients develop diarrhea, to stay within therapeutic levels for CyA. POSTER BOARD NUMBER P1 – 38 AN OPEN LABEL SINGLE CENTRE PILOT STUDY TO 952 CORRELATE THE PRETRANSPLANT C 2 BLOOD LEVEL (2HR POST SINGLE DOSE) OF TACROLIMUS AS A PREDICTOR OF POST TRANSPLANT TACROLIMUS DOSE IN DENOVO RENAL TRANSPLANTATION PATIENTS A. Sharma, M. Minz, V. Shetty Dept of Renal Transplant Surgery, PGIMER, Medical Advisor, Biocon