Case Report

Posttransplant Tacrolimus-Induced Diabetic Ketoacidosis: Review of the Literature

Table 1

Comparison of different characteristics of transplant recipients with tacrolimus-induced diabetes ketoacidosis [818] and our case.

Age (years), GenderOrgan transplantBMI (kg/m2)Duration since transplantation (month)Maintenance immunosuppressant regimenPresentationGlucose (mg/dl)/pH/ (mmol/l)HbA1C (%)Glucosuria, ketonuria, proteinuriaIA-2 Ab/GAD-65 AbTacrolimus level (ng/ml)ManagementDischarge regimen/outcome

Our case44 MKidney27.03TAC + PDN + MPSNausea, polyuria, abdominal pain493/7.32/159.8+/+/−NA/−13.9IV saline and insulin
Tapering TAC regimen
SC insulin
Off insulin in 9 months

Cho et al.35 FKidney21.86TAC + PDL + MMFPolydipsia, dry mouth, weight loss, anorexia, fatigue, confusion712/6.80/1.414.7NA/+/NANA/11.1IV saline and insulin 
CYC substituted for TAC
Diabetic diet

Dehghani et al.13 FLiverNA7TAC + MMFAnorexia, fatigue, dizziness, ascites742/7.22/10NA+/+/NANA/NA16.2IV saline and insulin Inpatient death secondary to bacterial sepsis

Dehghani et al.14 MLiverNA3TAC + PDLNausea, vomiting, fever390/7.26/10NA+/+/NANA/NA14.8IV saline and insulin SC insulin

Dehghani et al.14 MLiverNA4TAC + MMFAbdominal pain, fever432/7.21/12.2NANA/+/NANA/NA16.5IV saline and insulin SC insulin

Ersoy et al.42 FKidney29.836TAC + PDL + AZTPolyuria, polydipsia, confusion, fatigue520/7.16/7.911.6+/+/+NA/NA30IV saline and insulin 
CYC substituted for TAC  
MMF substituted for AZT
SC insulin 
Switched to OHA in 6 months

Im et al.22 FHeart22.47TACPolydipsia, anorexia, abdominal pain702/6.9/412.1+/+/NANA/NA>30IV saline and insulin 
Tapering TAC regimen
SC insulin 
Switched to OHA in 3 months

Keshavarz et al.14 FLiverNA12TAC + PDNChest pain, dyspnea980/7.08/1110.5+/+/+NA/NA24IV saline and insulin 
CYC substituted for TAC
SC insulin

Masood et al.17 MKidneyNA12TAC + PDL + MMFPolyuria, nocturia, dry mouth, anorexia, vomiting, confusion702/7.10/6NANA/+/NA/NAIV saline and insulin 
CYC substituted for TAC
SC insulin

Masood et al.55 FLiverNA24TAC + PDL + MMFPolyuria, dizziness474/NA/16.48.9NA/+/NANA/NANAIV saline and insulin SC insulin

Öztürk et al.17 MHeart15.43TAC + PDL + MMFDyspnea, fatigue574/7.22/13.39.7NA/+/NA/45.4IV saline and insulin 
Tapering TAC regimen
SC insulin

Solmaz et al.24 FBone marrow20.82TACLoss of consciousness890/6.9/49.1+/+/NANA/NANRIV saline and insulin 
CYC substituted for TAC
NA

Toyonaga et al.43 MKidney18.212TAC + MPLPolyuria, polydipsia, fatigue, weight loss925/7.34/23.811.8+/+/+/9.4IV saline and insulin  
Tapering TAC regimen
Diabetic diet

Tuğcu et al.44 MKidneyNA1TAC + PDL + MMFPolyuria, polydipsia, weakness862/7.27/1510.7+/+/NA/9.4IV saline and insulin  
Everolimus substituted TAC
SC insulin

Yoshida et al.50 FLiverNA9TAC + PDN + AZTPolyuria, polydipsia, visual blurring1227/6.93/3NANA/+/NANA/NA21.2IV saline and insulin  SC insulin

Abbreviations. BMI, body mass index; HgbA1C, hemoglobin A1C; IA-2 Ab, islet antigen 2 antibody; GAD-65 Ab, glutamic acid decarboxylase antibody; M, male; F, female; NA, not available; TAC, tacrolimus; PDN, prednisone; MPS, mycophenolate sodium; PDL, prednisolone; MMF, mycophenolate mofetil; AZT, azathioprine; MPL, methylprednisolone; CYC, cyclosporine; NR, normal range; IV, intravenous; SC, subcutaneous; OHA, oral hypoglycemic agents.