Table 2.

Summary of studies of immunosuppressant medications’ post-transplant diabetes mellitus effects

Agent	Study Year	Study Authors	Type of Study	Population Type	No. of Participants	Outcomes	PMID
Tacrolimus	1990	Starzl et al. (71)	Experimental drug observational study	Kidney (with and without other organ[s]) transplant recipients	36	FK506 has similar side effects as cyclosporin but potentially to a lesser degree	1693970
Tacrolimus	1991	Shapiro et al. (72)	Observational study	Kidney transplant recipients	65	FK506 has similar profile as cyclosporin but may be superior to cyclosporin in its hyperuricemia, hypertension, and hypercholesterolemia side effects	1703352
Tacrolimus	2001	Duijnhoven et al. (73)	Prospective longitudinal study	Kidney transplant recipients	18	Insulin sensitivity index if abnormal or indeterminate can be a risk factor for future development of diabetes after transplant	11181807
Tacrolimus	2002	Boots et al. (74)	Prospective study	Kidney transplant recipients	15	Decreased tacrolimus trough results in improvement in β-cell secretion and withdrawing steroids results in decreased LDL, HDL, total lipid, triglycerides, and HbA1c	11752041
Tacrolimus	2008	Porrini et al. (75)	Multicenter, prospective study	Kidney transplant recipients	154	Within 1 yr of transplant, 20% of transplant recipients receiving tacrolimus develop diabetes	18431233
Tacrolimus versus cyclosporin	1997	Pirsch et al. (76)	Randomized, open label study	Kidney transplant recipients	412	Incidence of post-transplant diabetes much higher with tacrolimus (19.9%) than with cyclosporin (4.0%), but lower rate of rejection with tacrolimus compared with cyclosporin	9112351
Tacrolimus versus cyclosporin	2007	Vincenti et al. (77)	Open label, randomized, multicenter study	Kidney transplant recipients	682	Incidence of impaired fasting glucose significantly higher with tacrolimus than with cyclosporin at 6 mo	17359512
Tacrolimus versus cyclosporin	2008	Ghisdal et al. (78)	Single-center, retrospective analysis	Kidney transplant recipients	54	Conversion to cyclosporin from tacrolimus significantly decreases HbA1c and fasting plasma glucose, and it may lead to remission of diabetes after transplant	17971033
Early steroid withdrawal versus chronic low-dose steroid treatment	2008	Woodle et al. (79)	Prospective, multicenter, randomized, double-blind, placebo-controlled trial	Kidney transplant recipients	386	Early steroid withdrawal is associated with an increased rate of acute rejection but has comparable long-term graft function as chronic low-dose steroid treatment	18936569
Sirolimus	2008	Johnston et al. (80)	Retrospective data analysis	Kidney transplant recipients	20,124	Sirolimus is associated with diabetes after transplantation	18385422
Sirolimus versus tacrolimus/MMF	2011	Flechner et al. (81)	Randomized trial	Kidney transplant recipients	443	Sirolimus-based regimens were not found to be superior in outcomes to tacrolimus/MMF	21668635
Sirolimus versus cyclosporin versus steroids	2011	Gyurus et al. (82)	Retrospective analysis	Kidney transplant recipients	514	Sirolimus treatment can be a risk factor for development of diabetes	21693238
Sirolimus versus calcineurin inhibitors	2013	Veroux et al. (83)	Retrospective study	Kidney transplant recipients	344	After development of diabetes after transplantation, converting from calcineurin inhibitors to sirolimus significantly improves or resolves the diabetes without increased risk of graft rejection	23762090
Corticosteroids	2015	Pirsch et al. (39)	Double-blind, prospective, randomized, controlled trial	Kidney transplant recipients	277	Early corticosteroid withdrawal has limited benefits compared with chronic low-dose prednisone	25881802
Belatacept versus cyclosporin	2011	Rostaing et al. (84)	Post hoc analysis of randomized, controlled trial	Kidney transplant recipients	336	Numerically better graft and patient survival at 12 mo in patients with diabetes on belatacept versus cyclosporin	21921152

PMID, PubMed reference number; HbA1c, hemoglobin A1c; MMF, mycophenolate mofetil.