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Page 8 of 14 Jagpal et al. Vessel Plus 2018;2:24 I http://dx.doi.org/10.20517/2574-1209.2018.27

HbA1c of patients on tacrolimus or ciclosporin

38 ± 11.38
42 ± 1.26

Figure 3. HbA1c of heart transplant patients on tacrolimus or ciclosporin at one time interval (mean ± SD)

DISCUSSION
Principle findings
This study confirmed the risk of post-transplant diabetes is worse in heart transplant patients treated with
tacrolimus-based maintenance immunosuppression compared with those treated with ciclosporin, when
using mean fasting glucose as an indicator. The difference was significant at 9 months post-operatively. This
timing fits with changes in the unit’s drug regimen, especially the removal of corticosteroids which also
contribute to altered glucose metabolism. In both cohorts, fasting glucose normalises at 12 months, further
emphasising the role of corticosteroids in the results produced.

The mean HbA1c was greater in the ciclosporin treated cohort. At the beginning of the study, the two
cohorts were comparable, with many relevant contributors to post-transplant diabetes considered- including
age, sex, weight, creatinine, pretransplant diagnosis and diagnosis of diabetes.

Context of research
Much evidence involving the effectiveness of both tacrolimus and ciclosporin is based on data from kidney
[33]
and liver transplantation. For that reason, Reichart et al. (2001) conducted a large European multicentre
study to investigate the effectiveness of both CNIs in heart transplant recipients. With a study population
of 82 patients across 5 centres, they found that when combined with azathioprine and corticosteroids,
tacrolimus was just as effective as ciclosporin. While this three-year follow up confirmed tacrolimus a
viable alternative for ciclosporin in heart transplantation, Reichart and colleagues also observed a higher
proportion of patients treated with tacrolimus requiring insulin for PTDM, a consequence that would affect
[33]
the morbidity and mortality of patients in years to come .
[34]
Another multicentre study published a few months later Taylor et al. (1999) compared tacrolimus and
ciclosporin to find both equally safe and effective maintenance immunosuppression in heart transplantation.
They did observe a higher rate of hypertension and hyperlipidaemia in patients receiving tacrolimus. This
was a significant finding as both hypertension and hyperlipidaemia negatively impact renal function. There
was also no difference in the incidence of diabetes or hyperglycaemia between the two groups. This, at the
time, differed from liver and kidney trials where diabetes was significantly more common in tacrolimus