Tacrolimus and posttransplant diabetes mellitus in renal transplantation

Up to 63% of renal transplant patients die as a result of cardiovascular disease (1). Among other factors, hypertension, hyperlipidemia, and posttransplant diabetes mellitus (PTDM) contribute to this cardiovascular mortality (2). Most renal transplants are performed with cyclosporine- or tacrolimus-based immunosuppression. Compared with cyclosporine, tacrolimus has lower unfavorable effects on blood pressure, serum lipids, and renal function. In contrast, tacrolimus use is associated with a higher incidence of PTDM. There is substantial evidence from studies in the general population that diabetes is a strong risk factor for cardiovascular disease, and this has also been shown for renal transplant recipients (2).