Uchida J, Iwai T, Kabei K, Machida Y, Kuwabara N, Naganuma T, Kumada N, Nakatani T
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Transplant Proc. 2014;46(2):532-6. doi: 10.1016/j.transproceed.2013.11.146.
The adverse effects of tacrolimus are known to play major roles in new-onset diabetes after transplantation. The purpose of this study was to investigate the effects of conversion from a twice-daily tacrolimus (Tac-BID) to a once-daily tacrolimus (Tac-OD) on glucose metabolism in stable kidney transplant recipients.
Twenty-six patients were converted from Tac-BID to Tac-OD on a 1:1 mg basis and examined for its effects on glucose metabolism. Unless rejection or tacrolimus toxicity was suspected, we did not perform dose adjustments of Tac-OD or reconversion to Tac-BID until 4 weeks after conversion. Subsequent dose adjustments were allowed to maintain tacrolimus target trough concentration within the. Changes in clinical parameters were compared between baseline and 24 weeks after conversion.
Conversion from Tac-BID to Tac-OD on a 1:1 mg basis resulted in a significant decrease in tacrolimus trough level at 4 weeks after conversion. Because dose adjustments were performed, the trough level did not differ significantly between baseline and 24 weeks after conversion. At 4 and 24 weeks after conversion, the homeostasis model assessment of pancreas β-cell function (HOMA-β) increased significantly.
Although there was no change in tacrolimus trough level between baseline and 24 weeks after transplantation, HOMA-β at 24 weeks after conversion was significantly higher than that at baseline. These results indicated that conversion from Tac-BID to Tac-OD may improve pancreas β-cell function in kidney transplant recipients.
已知他克莫司的不良反应在移植后新发糖尿病中起主要作用。本研究的目的是调查将稳定的肾移植受者的他克莫司每日两次给药（Tac-BID）转换为每日一次给药（Tac-OD）对糖代谢的影响。
26例患者按1:1毫克的比例从Tac-BID转换为Tac-OD，并检查其对糖代谢的影响。除非怀疑有排斥反应或他克莫司毒性，在转换后4周之前我们不进行Tac-OD的剂量调整或重新转换回Tac-BID。允许后续进行剂量调整以将他克莫司目标谷浓度维持在……范围内。比较转换前后基线和24周时临床参数的变化。
按1:1毫克的比例从Tac-BID转换为Tac-OD导致转换后4周时他克莫司谷浓度显著降低。由于进行了剂量调整，转换后基线和24周时的谷浓度无显著差异。转换后4周和24周时，胰腺β细胞功能的稳态模型评估（HOMA-β）显著增加。
虽然移植后基线和24周时他克莫司谷浓度没有变化，但转换后24周时的HOMA-β显著高于基线时。这些结果表明，从Tac-BID转换为Tac-OD可能改善肾移植受者的胰腺β细胞功能。
