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PTDM Tacrolimus Mechanism — ESENeph MCQ

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ModerateTransplantationPTDM Tacrolimus MechanismESENeph

A kidney transplant recipient on Tacrolimus develops post-transplant diabetes mellitus (PTDM). His Tacrolimus trough is 8 ng/mL. His clinician considers reducing Tacrolimus. What is the diabetogenic mechanism of Tacrolimus?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Tacrolimus is directly toxic to pancreatic beta-cells and impairs insulin secretion; it also increases insulin resistance

Tacrolimus is more diabetogenic than Ciclosporin. It causes PTDM through direct beta-cell toxicity (inhibiting calcineurin-NFAT signalling required for insulin gene transcription) and by increasing insulin resistance. The incidence of PTDM with Tacrolimus is 15-30% vs 5-15% with Ciclosporin. KDIGO 2009 recommends considering Tacrolimus dose reduction or switching to Ciclosporin if PTDM develops, balancing against rejection risk. Modifiable risk factors include Prednisolone dose, obesity, and family history.

Reference: KDIGO 2009 – Transplant Guideline; Shivaswamy et al 2016 – PTDM Review