Heisel Olaf, Heisel Rochelle, Balshaw Robert, Keown Paul
Department of Pathology and Laboratory Medicine, University of British Columbia, Canada.
Am J Transplant. 2004 Apr;4(4):583-95. doi: 10.1046/j.1600-6143.2003.00372.x.
New onset diabetes mellitus (NODM) is a serious complication of transplantation. This meta-analysis evaluates the reported incidence of NODM after solid organ transplantation in patients receiving CNI treatment. Databases from January 1992 to April 2002 were searched. Fifty-six publications providing NODM incidence data were reviewed. Sixteen prospective, randomized comparative studies providing information on incidence of insulin-dependent diabetes mellitus (IDDM) were subjected to meta-analysis. New onset diabetes mellitus was reported in 13.4% of patients after solid organ transplantation, with a higher incidence in patients receiving tacrolimus than cyclosporine (16.6% vs. 9.8%). This trend was observed across renal, liver, heart and lung transplant groups. Meta-analysis of 16 studies included patients receiving either tacrolimus (n=1636) or cyclosporine (n=1407). The incidence of IDDM was significantly higher among tacrolimus-treated patients (10.4% vs. 4.5%, p<0.00001), an effect observed in renal (9.8% vs. 2.7% p<0.00001) and nonrenal (11.1% vs. 6.2%; p<0.003) groups, and among patients receiving equal doses of concomitant medication in both treatment arms (12.0% vs. 3.0%; p<0.00001). The reported incidence of NODM during the past decade was significantly higher among patients receiving tacrolimus than cyclosporine. These data provide a quantitative foundation for studies designed to reduce the rates of NODM following solid organ transplantation.
新发糖尿病（NODM）是移植的一种严重并发症。本荟萃分析评估了接受钙调神经磷酸酶抑制剂（CNI）治疗的实体器官移植患者中报告的NODM发病率。检索了1992年1月至2002年4月的数据库。对56篇提供NODM发病率数据的出版物进行了综述。对16项提供胰岛素依赖型糖尿病（IDDM）发病率信息的前瞻性、随机对照研究进行了荟萃分析。实体器官移植后13.4%的患者报告发生了新发糖尿病，接受他克莫司治疗的患者发病率高于环孢素（16.6%对9.8%）。在肾、肝、心和肺移植组中均观察到这一趋势。对16项研究的荟萃分析纳入了接受他克莫司（n = 1636）或环孢素（n = 1407）治疗的患者。他克莫司治疗的患者中IDDM的发病率显著更高（10.4%对4.5%，p<0.00001），在肾移植组（9.8%对2.7%，p<0.00001）和非肾移植组（11.1%对6.2%；p<0.003）以及两个治疗组中接受等量伴随药物治疗的患者中均观察到这一效应（12.0%对3.0%；p<0.00001）。在过去十年中，接受他克莫司治疗的患者中报告的NODM发病率显著高于接受环孢素治疗的患者。这些数据为旨在降低实体器官移植后NODM发生率的研究提供了定量基础。
