The effects of maintenance doses of FK506 versus cyclosporin a on glucose and lipid metabolism after orthotopic liver transplantation

Background. Posttransplant diabetes mellitus (PTDM) has gained widespread attention due to the micro and macro-vascular complications that increase the morbidity and mortality of patients receiving solid organs. The higher incidence of PTDM has been mainly attributed to the immunosuppressive therapy. Therefore, this study compares the metabolic side effects of low dose maintenance therapy of FK-506 and Cyclosporin A (CsA) in 14 patients 1 year after orthotopic liver transplant and analyzes possible factors that contribute to the development of PTDM. Methods. Two groups (n=7) differing in their immunosuppressive regimen (FK506 or CsA) were matched to eight control subjects and compared to each other. The effects of in vivo insulin action were assessed by means of the euglycemic hyperinsulinemic clamp technique. Arginine stimulation tests at normo- (5.5 mM) and hyperglycemic (15 mM) levels were performed and the acute insulin, C-peptide and glucagon response (2-5 min) to arginine were determined. Results. Insulin sensitivity (total glucose disposal) was statistically lower in patients treated with FK-506 and CsA (5.05±0.47 and 5.05±0.42 mg/kg/min) as compared to controls (6.62±0.38 mg/kg/min) (P