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Nakil Sonrası Diabetes Mellitus Gelişen Renal Transplant Alıcılarında İdame Bağışıklığı Baskılayıcı Tedavide Tam Doz Siklosporine Karşın Düşük Doz Takrolimus

Full Dose Cyclosporine Versus Low Dose Takrolimus as Maintenance Immunosuppression in Renal Transplant Recipients with Posttransplant Diabetes Mellitus

Journal Name:

  • Türk Nefroloji, Diyaliz ve Transplantasyon Dergisi

Publication Year:

  • 2012
DOI: 
DOI 10.5262/tndt.2012.1002.10

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
OBJECTIVE : The aim of our study was to determine the effect and safety of low dose tacrolimus instead of switching to cyclosporine in patients with new onset diabetes after renal transplantation (NODAT) associated with takrolimus use. MATER IAL and MethodS: Sixty six patients who underwent renal transplantation at our center between 2003 and 2008 and diagnosed NODAT in accordance to ADA criteria were included in the study. Patients were allocated into two groups; group 1: low dose tacrolimus users (n:36 patients), group 2: those who were switched to standard doses of cyclosporine (n: 30 patients). Glycemia controls during the preceding and following year of DM diagnosis, total acute rejection ratios, graft functions and graft survival ratios were compared. Results : Blood glucose levels were similar in the first 6 months, but were lower in the cyclosporine group at the end of the first year (p:0,022),. On the other hand, HbA1C levels were found to be lower at 6th month in tacrolimus group(p: 0,03). Acute rejection and graft survival ratios were similar. The glomerular filtration rate was higher at the 6th month in low dose tacrolimus group. Conc lusion : Low dose tacrolimus or switching to a standard cyclosporine protocol have similar effects in patients with NODAT associated with tacrolimus use.
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Abstract (Original Language): 
Amaç : Çalışmamızda takrolimus kullanmakta iken diabetes mellitus (DM) gelişen böbrek nakli alıcılarında; siklosporine geçmek yerine düşük doz takrolimusa devam etmenin etkinlik ve güvenilirliğinin karşılaştırılması amaçlanmıştır. Gereç ve YÖNTEMler: Çalışmaya 2003-2008 yılları arasında merkezimizde böbrek nakli yapılmış ve ADA ölçütlerine göre DM tanısı konulan 66 hasta (E/K:46/20) alındı. Hastalar DM tanısı sonrası iki gruba ayrıldı; Grup 1: Takrolimus dozu düşürülerek tedaviye devam edilenler (36 hasta), Grup 2: Standart doz siklosporine geçilenler (30 hasta). DM tanısı öncesi ve sonrası 1 yıl içindeki glisemi kontrolü, ayrıca total akut rejeksiyon oranları, greft sağkalım oranları ve greft işlevleri karşılaştırıldı. Bulgular: Gruplar arasında açlık kan şekeri düzeyleri ilk 6 ayda birbirine benzerken 1. yıl sonunda siklosporin grubunda(119 mg/dl (66- 514) - 105,5 mg/dl (70- 170); p:0,022), 6. aydaki HbA1C düzeyinin ise takrolimus grubunda daha düşük olduğu (grup1-2 sırayla 6,4±0,9 / 7,2±0,9, p: 0,03) saptandı. Akut rejeksiyon ve greft sağkalımı oranlarının benzer, 6. ay’daki glomerüler filtrasyon hızlarının düşük doz takrolimus grubunda daha yüksek (grup 1-2 sırayla; 82,5±19,9 ml/dk/ 69,6±21,9 ml/dk; p:0,015) olduğu görüldü. Son uç: Takrolimus kullanmakta iken DM gelişen böbrek nakli hastalarında standart siklosporin protokolüne dönüşüm veya düşük doz takrolimus rejimi ile tedaviye devam edilmesi yaklaşımları kan şekeri ayarlanması, greft işlevleri ve akut rejeksiyon atakları açısından benzer etkinliktedir.
FULL TEXT (PDF): 
PDF icon arastrmx_172977_21_pp_161-166.pdf
  • 2
161-166
  • Turkish

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