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Calcineurin inhibitor effects on glucose metabolism and endothelial function following renal transplantation

Anders Asberg1, Karsten Midtvedt, Monica H Voytovich

  • 1Laboratory for Renal Physiology, Medical Department, Rikshospitalet Medical Center, Oslo, Norway. anders.asberg@farmasi.uio.no

Clinical Transplantation
|February 13, 2009
PubMed
Abstract

Insights

Long-term calcineurin inhibitor (CNI) treatment negatively impacts glucose metabolism in renal transplant recipients, potentially increasing cardiovascular disease risk. CNI avoidance improved insulin sensitivity post-transplant.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiovascular Science

Background:

  • Calcineurin inhibitors (CNI) are implicated in post-transplant diabetes mellitus (PTDM) development.
  • PTDM pathogenesis involves altered insulin secretion and sensitivity, linked to endothelial dysfunction.

Purpose of the Study:

  • To compare the effects of CNI treatment versus CNI avoidance on glucose metabolism and endothelial function in renal transplant recipients.
  • To assess insulin secretion and sensitivity at 10 weeks and 12 months post-transplantation.

Main Methods:

  • A substudy of a randomized trial involving renal transplant recipients.
  • Comparison of CNI treatment (n=23) versus complete CNI avoidance (n=21).
  • Assessment of insulin secretion/sensitivity (oral glucose tolerance test) and endothelial function (laser Doppler flowmetry) at 10 weeks and 12 months.

Main Results:

  • Insulin sensitivity was significantly better in patients never treated with CNI drugs at 12 months post-transplant (p=0.043).
  • Insulin secretion tended to be higher in CNI-treated patients at both time points (p=0.068).
  • No significant differences in endothelial function were observed between groups at 10 weeks or 12 months.

Conclusions:

  • Long-term CNI treatment appears to negatively affect glucose metabolism in renal transplant recipients.
  • This metabolic impact may contribute to the elevated risk of premature cardiovascular disease in CNI-treated patients.
  • Further research is required to confirm this hypothesis.

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