Calcineurin inhibitors induced post-transplant diabetes mellitus: A risk worth taking

Abstract

Discovering miraculous medicines for the treatment of protracted diseases have long been a principal objective of the pharmaceutical scientists. Calcineurin inhibitors that include tacrolimus and cyclosporine are widely utilized for the inhibition of post-transplant tissue rejection. However, practice of these drugs is associated with certain complications such as diabetes mellitus onset after transplantation or post-transplant diabetes mellitus (PTDM). This PTDM renders the patients with eminent endangerments of diabetes mellitus, cardiovascular complications and impairs the survival rate. This review focuses on the complications caused by calcineurin inhibitors, determines the risk-to-benefit ratio of using these immuno-suppressants and discusses the various treatment options to treat onset of diabetes. It was observed that the non-diabetic and dialysis patients administered with tacrolimus were witnessed with decreased insulin release without instigating insulin resistance. This investigation was found to be dose dependent. Previous reports also suggest that the withdrawal of corticosteroids from their combination with tacrolimus result a decrease in insulin resistance, however, had inadequate influence on insulin secretion. Furthermore, a decrease of 30% in tacrolimus serum concentrations demonstrated a 24 % increase in insulin and 36 % increase in secretion of C-peptide. On the basis of these studies, it is evident that the effect of cyclosporine and tacrolimus on the secretion of insulin is reversible and dose dependent.