Giordano M, Colella V, Dammacco A, Torelli C, Grandaliano G, Teutonico A, Depalo T, Caringella D A, Di Paolo S
Pediatric Nephrology and Dialysis Unit, Children's Hospital Giovanni XXIII, University of Bari, 70126 Bari, Italy.
J Endocrinol Invest. 2006 Apr;29(4):330-6. doi: 10.1007/BF03344104.
Post-transplant diabetes mellitus (PTDM) and impaired glucose tolerance are now considered among the major adverse events following organ transplantation. The present study was aimed at investigating the regulation of glucose metabolism in pediatric recipients of a kidney transplant (KT), receiving tacrolimus or cyclosporine A-based immunosuppression. Twelve subjects, eight males and four females, aged 12.1+/-3.8 yr, and with a mean time from KT of 45.6 months were enrolled in the study. All patients had a basal evaluation of fasting glucose (GF), fasting insulin (IF), C-peptide and glycated hemoglobin (HbA1c) levels. They then underwent oral glucose tolerance test (OGTT), with measurement of blood glucose and insulin concentration. Two children had impaired GF, associated with supernormal HbA1c levels, one patient showed impaired glucose tolerance, none had PTDM. Peripheral insulin resistance, as measured by quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment estimate of insulin sensitivity (HOMA-IR) index, was enhanced in 3 patients. Subsequently, GF significantly increased with time from transplant (p=0.01), while fasting C-peptide and the area under the curve of insulin correlated with creatinine clearance. In conclusion, our results, although generated in a small sample size, would suggest that long-term follow-up of children receiving a KT should extend to explore the response to oral glucose load and at least the basal measure of insulin response.
移植后糖尿病（PTDM）和糖耐量受损现在被认为是器官移植后的主要不良事件。本研究旨在调查接受他克莫司或环孢素A免疫抑制的儿童肾移植（KT）受者的葡萄糖代谢调节情况。12名受试者，8名男性和4名女性，年龄12.1±3.8岁，肾移植平均时间为45.6个月，被纳入研究。所有患者均对空腹血糖（GF）、空腹胰岛素（IF）、C肽和糖化血红蛋白（HbA1c）水平进行了基础评估。然后他们接受了口服葡萄糖耐量试验（OGTT），测量血糖和胰岛素浓度。两名儿童空腹血糖受损，伴有HbA1c水平超常，一名患者糖耐量受损，无人患有移植后糖尿病。通过定量胰岛素敏感性检查指数（QUICKI）和胰岛素敏感性稳态模型评估估计值（HOMA-IR）指数测量的外周胰岛素抵抗在3名患者中增强。随后，空腹血糖随移植时间显著增加（p=0.01），而空腹C肽和胰岛素曲线下面积与肌酐清除率相关。总之，我们的结果虽然是在小样本中得出的，但表明接受肾移植儿童的长期随访应扩展到探索对口服葡萄糖负荷的反应以及至少胰岛素反应的基础测量。
