The relative role of
steroids and
tacrolimus in the development of
glucose metabolic disorders and
hyperlipidemia after
renal transplantation has not yet been clearly established. Therefore,
glucose metabolism was prospectively evaluated by intravenous
glucose tolerance test, as was
lipid profile, in fifteen white nondiabetic renal transplant recipients three times: before and after
steroid withdrawal and after
tacrolimus trough level reduction. After withdrawal of 10 mg of
prednisolone,
insulin resistance decreased (fasting
C-peptide, 0.99 to 0.77 nmol/L [P < 0.0009]; fasting
insulin, 9.5 to 8.1 mU/L [P = 0.09];
insulin/
glucose ratio, 1.85 to 1.45 mU/mmol [P = 0.10]) and
lipid levels decreased (total
cholesterol, 5.1 to 4.2 mmol/L [P = 0.006]);
HDL cholesterol, 1.4 to 1.1 mmol/L [P = 0.01];
LDL cholesterol, 3.0 to 2.5 mmol/L [P = 0.15];
triglycerides, 1.52 to 0.91 mmol/L [P = 0.02]). After
tacrolimus trough level reduction from 9.5 to 6.4 ng/ml, pancreatic beta-cell secretion capacity improved (
C-peptide secretion increased from 49.0 to 66.6 nmol x min/L [P = 0.04] and insulin secretion increased from 1134 to 1403 mU x min/L [P = 0.06]). HbA1c improved also, from 5.9 to 5.3% (P = 0.002).
Lipids did not change. In conclusion,
steroid withdrawal resulted in a decrease in
insulin resistance and a reduction in
lipids, and
tacrolimus trough level reduction resulted in an improved pancreatic beta-cell secretion capacity. Therefore, these therapeutic measurements may contribute to the reduction of the cardiovascular morbidity and mortality in renal transplant recipients.