Prospective randomized study of conversion from tacrolimus to cyclosporine A to improve glucose metabolism in patients with posttransplant diabetes mellitus after renal transplantation
Few high-quality data exist on the management of patients with PTDM. In this context of relative
uncertainty physicians are confronted daily with challenging clinical situations that require to integrate a
series of concepts which are the efficacy of immunosuppressive therapy, the immunological risk that is
conditioned by patient characteristics and the moment after transplantation, as well as the metabolic
side effect profile of immunosuppressive medication. In addition, other factors such as age and frailty of
the patient, and the quality of the graft have to be considered in taking decisions about possible
adjustments of the immunosuppressive management.
1. Provide immunosuppressive therapy with optimal protection against acute rejection during the
first months after transplantation when the risk of acute rejection is highest.
2. Avoid labeling the patient as having PTDM before attaining the maintenance dose of
corticosteroids and calcineurin inhibitors. This will normally be the case 2-3 months after renal
3. Consider the immunological risk of the patient when adjusting the immunosuppressive regimen
in order to improve glucose metabolism.
The American Society of Transplant Surgeons (ASTS) is accredited by the Accreditation Council for
Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
ASTS designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1 Credit™.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Karl Martin Wissing has received grants, travel support, and honoraria from Astellas, Novartis, Amgen,
Bellco, Roche, and Pfizer.
Instructions for completing ASTS MOC – Education through AJT modules
*Please note, you must hit the “next” button at the bottom left after each step to continue in the
1. Review article.
2. Complete post-test. A passing score of 75% is required to move forward. The test can be retaken
as many times as necessary.
3. Complete the evaluation.
4. Access your AJT MOC certificate(s) and transcript of modules completed under the “My
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