Kotha S, Lawendy B, Asim S, Gomes C, Yu J, Orchanian-Cheff A, Tomlinson G, Bhat M. Impact of immunosuppression on incidence of post-transplant diabetes mellitus in solid organ transplant recipients: Systematic review and meta-analysis. World J Transplant 2021; 11(10): 432-442 [PMID: 34722172 DOI: 10.5500/wjt.v11.i10.432]
Corresponding Author of This Article
Sreelakshmi Kotha, MBBS, MRCP, Staff Physician, Department of Gastroenterology, Guy's and St Thomas' Hospital, Westminster B ridge Road, London SE1 7JD, United Kingdom. sreelakshmi.kotha@gstt.nhs.uk
Research Domain of This Article
Transplantation
Article-Type of This Article
Meta-Analysis
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Oct 18, 2021; 11(10): 432-442 Published online Oct 18, 2021. doi: 10.5500/wjt.v11.i10.432
Impact of immunosuppression on incidence of post-transplant diabetes mellitus in solid organ transplant recipients: Systematic review and meta-analysis
Sreelakshmi Kotha, Bishoy Lawendy, Saira Asim, Charlene Gomes, Jeffrey Yu, Ani Orchanian-Cheff, George Tomlinson, Mamatha Bhat
Sreelakshmi Kotha, Department of Gastroenterology, Guy's and St Thomas' Hospital, London SE1 7JD, United Kingdom
Bishoy Lawendy, Charlene Gomes, Jeffrey Yu, Ani Orchanian-Cheff, Department of Multi-Organ Transplantation, Toronto General Hospital, Toronto M5G 2C4, Canada
Saira Asim, Multi Organ Transplant Program, Toronto General Hospital, Toronto M5G 2C4, Canada
George Tomlinson, Dalla Lana School of Public Health, Department of Medicine, University Health Network - Toronto General Hospital, University of Toronto, Toronto M5G 2C4, Canada
Mamatha Bhat, Multi-organ Transplant, Toronto General Hospital, Toronto M5G 2C4, Canada
Author contributions: Kotha S and Bhat M designed the study; Kotha S, Lawendy B, Asim S, Gomes C, Yu J and Bhat M collected the data; Kotha S, Lawendy B, Tomlinson G and Bhat M wrote the paper; Orchanian-Cheff A did the literature search; Tomlinson G made the data analysis; and All authors finally approved this manuscript.
Conflict-of-interest statement: There is no conflict of interest for any of the authors
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sreelakshmi Kotha, MBBS, MRCP, Staff Physician, Department of Gastroenterology, Guy's and St Thomas' Hospital, Westminster B ridge Road, London SE1 7JD, United Kingdom. sreelakshmi.kotha@gstt.nhs.uk
Received: June 20, 2021 Peer-review started: June 20, 2021 First decision: July 28, 2021 Revised: August 27, 2021 Accepted: September 19, 2021 Article in press: September 19, 2021 Published online: October 18, 2021
ARTICLE HIGHLIGHTS
Research background
Post-transplant diabetes mellitus (PTDM) is associated with significant morbidity and mortality, with increased cardiovascular risk, infection and graft failure. The reported incidence of PTDM ranges from 4%-25% in renal transplant recipients, 2.5%-25% in liver transplant recipients, 4%-40% in heart transplant recipients, and 30%-35% in lung transplant recipients.
Research motivation
This research will help clinicians recognise the risk-benefit of various immunosuppressants for PTDM.
Research objectives
The aim of this study is to perform a systematic review and meta-analysis to estimate incidence of PTDM and compare the effects of the 3 major immunosuppressants on incidence of PTDM
Research methods
The authors performed a systematic review and meta-analysis as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement standards.
Research results
This network meta-analysis (NMA) reveals sirolimus and tacrolimus to be significantly more diabetogenic than cyclosporine. Tacrolimus is more diabetogenic in the short-term (2-3 years post-transplant), whereas sirolimus tends to exhibit higher diabetogenicity in the long-term (5-10 years post-transplant).
Research conclusions
This NMA reveals sirolimus and tacrolimus to be significantly more diabetogenic than cyclosporine. Tacrolimus is more diabetogenic in the short-term (2-3 years post-transplant), whereas sirolimus tends to exhibit higher diabetogenicity in the long-term (5-10 years post-transplant). This research will aid clinicians in understanding the important risk factors for PTDM, and encourages careful evaluation of the benefit–risk ratio of different immunosuppressant regimens in the transplant patients.
Research perspectives
Focused studies on patients on sirolimus to get more information on pathophysiology of PTDM development required.
