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Jagpal et al. Vessel Plus 2018;2:24 Vessel Plus
DOI: 10.20517/2574-1209.2018.27

Original Article Open Access

Is tacrolimus more likely to induce diabetes mellitus
than ciclosporin in heart transplant patients?

Anisha Jagpal , Sudeep Das De , Sanjeet Singh Avtaar Singh , Alan Kirk 2
1
2
2
1 College of Medical, Veterinary and Life Sciences, University Avenue, University of Glasgow, Glasgow G12 8QQ, UK.
2 Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow G81 4DY, UK.
Correspondence to: Mr. Sanjeet Singh Avtaar Singh, Department of Cardiothoracic Surgery, Golden Jubilee National Hospital,
Glasgow G81 4DY, UK. E-mail: sanjeetsingh@nhs.net
How to cite this article: Jagpal A, Das De S, Avtaar Singh SS, Kirk A. Is tacrolimus more likely to induce diabetes mellitus than
ciclosporin in heart transplant patients? Vessel Plus 2018;2:24. http://dx.doi.org/10.20517/2574-1209.2018.27

Received: 28 Apr 2018 First Decision: 23 Jul 2018 Revised: 25 Jul 2018 Accepted: 2 Aug 2018 Published: 13 Sep 2018
Science Editors: Mario F. L. Gaudino, Cristiano Spadaccio Copy Editor: Huan-Liang Wu Production Editor: Zhong-Yu Guo

Abstract
Aim: Immunosuppression has evolved since the first successful orthotopic heart transplant 50 years ago. Currently,
calcineurin inhibitors lie at the focal point of the immunosuppressive regimen. However, these drugs exhibit a variety
of side effects, including hyperglycaemia. This in turn compounds the risk of cardiovascular disease. There is conflict
around which calcineurin inhibitor, tacrolimus or ciclosporin, is more likely to induce diabetes.
Methods: A retrospective analysis of data from 52 patients who had received a heart transplantation at the Scottish
heart transplant unit between January 2011 and August 2017. All patients received a combination immunosuppressive
regimen consisting of mycophenolate mofetil, corticosteroids and either tacrolimus or ciclosporin. Fasting glucose levels
were compared every 3 months after transplantation for a year. HbA1c was collected and compared at one interval
during follow-up postoperatively. Statistical analysis was achieved using Students t-test for continuous variables and
Chi-squared test for categorical variables.

Results: The drug regimens remained unchanged in the two cohorts over the study period. The fasting glucose of
tacrolimus treated patients was higher over the 12-month period compared to ciclosporin treated patients (7.3 ± 1 vs.
5.9 ± 0.5, P = 0.017). The results were significantly higher in the tacrolimus group at 9 months (P = 0.013). In contrast
to these findings, HbA1c of the tacrolimus group was lower than the ciclosporin group, although there was no significant
difference (38 ± 11.4 vs. 43 ± 1.3, P = 0.104).

Conclusion: This study suggests a relationship between tacrolimus and rising fasting glucose among heart transplant
population. However, a longer follow-up and control of confounding variables is required to denote the long-term impact
of immunosuppression related diabetes in heart transplant patients.

Keywords: Immunosuppression, heart transplantation, tacrolimus, ciclosporin, diabetes
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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