New Onset Diabetes after Kidney Transplantation (NODAT): Impact of Tacrolimus Cessation on Outcomes

Background Calcineurin inhibitors (CNIs) are toxic to islet cells and a potential cause of NODAT, occurring in 3-20% of recipients. The impact of converting tacrolimus to an alternate immunosuppressant to reverse NODAT has not been tested in paediatric kidney recipients on steroid free (SF) vs steroid inclusive (SI) protocols. Objectives To test whether conversion of tacrolimus to an alternative agent is associated with normalisation (HbA1c <5.7) or partial normalisation (HbA1c <6.5) of NODAT/IGT. Design/Methods Data was retrospectively collected on all paediatric patients diagnosed with IGT or NODAT between 1/1/2013 and 31/12/2023 who were <21 years at the time of transplant on either SF or SI protocol. Results Of the 49 included patients, 7 (27%) on a SF protocol were switched to an alternative agent compared with 6 (26%) on a SI protocol. Tacrolimus was changed to cyclosporine (CSA) in all patients, as it has less islet cell toxicity. Following conversion to CSA, there was normalisation of HbA1c in four of the patients on the SF protocol, but in only one patient on the SI protocol. Three patients in the SF versus two in the SI group showed partial normalisation of HbA1c. Median follow up time was 11 months for patients on the SF protocol and 6.5 months on the SI protocol. Conclusions In our small group of patients switched from tacrolimus to CSA, patients on an SI protocol may have a lower likelihood of normalisation of HbA1c after IGT or NODAT, compared with patients on a SF protocol.