Table 2.

Approaches to Control of Metabolic Derangements and Rational Immunosuppression.

Metabolic parameters	Management options	Rational immunosuppression
Low-density lipoprotein >100 mg/dL Higher triglycerides	•Lifestyle modification •Diet changes •Statins/ezetimibe if not controlled by diet and lifestyle •Fibric acid derivatives, fish oils	•CNI reduction and addition of mycophenolate •Cyclosporine conversion to tacrolimus
Diabetes mellitus	•Target HbA1c < 7% •Lifestyle changes •Oral antidiabetics •Insulin may be preferred when on high doses of steroids	•Steroid short-term only •Steroid-free protocols •Tacrolimus to cyclosporine
Hypertension	•Blood pressure 130/80 mm Hg •Calcium channel blockers: amlodipine/nifedipine may be the preferred drug of choice	Steroid and CNI minimization

CNI, calcineurin inhibitors.