Rosiglitazone treatment of diabetes mellitus after solid organ transplantation

Background. Diabetes mellitus is a common clinical problem after solid organ transplantation. Whether patients have preexisting diabetes or develop posttransplant diabetes, insulin therapy is usually required. Achieving excellent diabetic control is an important target in reducing the incidence of cardiovascular disease after transplantation. Methods. The authors treated 18 patients with type 2 diabetes after transplantation with rosiglitazone. Eleven patients had preexisting type 2 diabetes and seven patients developed posttransplant diabetes. Rosiglitazone was added to insulin or glyburide to improve elevated hemoglobin Hb A(1C) levels in patients with preexisting diabetes or was used to try to avoid insulin therapy in posttransplant diabetics. Blood levels of cyclosporine, tacrolimus, creatinine, and HbA(1C) were followed for a mean of 381 days (range, 133-718 days). Results. The addition of rosiglitazone did not cause any significant changes in serum creatinine, cyclosporine, or tacrolimus. There were no significant changes in cyclosporine or tacrolimus doses. Mean HbA(1C) improved from 8.1+/-1.5% to 6.9+/-1.3% (P=0.01) in the 18 patients and from 8.6+/-1.5% to 6.7+/-0.5% (P=0.035) in the 7 patients with posttransplant diabetes. All patients with posttransplant diabetes were well controlled without insulin therapy. Conclusions. Rosiglitazone is a safe and effective oral agent for the treatment of diabetes mellitus after solid organ transplantation. It is the first agent to allow successful oral therapy for patients with posttransplant diabetes, and is a well-tolerated alternative to insulin for these patients.