Received November 14, 2007
Accepted on February 2, 2008

CLINICAL EPIDEMIOLOGY

Sirolimus Is Associated with New-Onset Diabetes in Kidney Transplant Recipients

Olwyn Johnston ^*, Caren L. Rose ^*, Angela C. Webster , and John S. Gill ^*1

*Division of Nephrology, St. Paul’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada; and National Health and Medical Research Council Centre for Clinical Research Excellence in Renal Medicine, Children’s Hospital at Westmead, Sydney, New South Wales, Australia

¹ To whom correspondence should be addressed. E-mail: jgill{at}providencehealth.bc.ca.

	Abstract

New-onset diabetes (NOD) is associated with transplant failure. A few single-center studies have suggested that sirolimus is associated with NOD, but this is not well established. With the use of data from the United States Renal Data System, this study evaluated the association between sirolimus use at the time of transplantation and NOD among 20,124 adult recipients of a first kidney transplant without diabetes. Compared with patients treated with cyclosporine and either mycophenolate mofetil or azathioprine, sirolimus-treated patients were at increased risk for NOD, whether it was used in combination with cyclosporine (adjusted hazard ratio [HR] 1.61; 95% confidence interval [CI] 1.36 to 1.90), tacrolimus (adjusted HR 1.66; 95% CI 1.42 to 1.93), or an antimetabolite (mycophenolate mofetil or azathioprine; adjusted HR 1.36; 95% CI 1.09 to 1.69). Similar results were obtained in a subgroup analysis that included the 16,861 patients who did not have their immunosuppressive regimen changed throughout the first posttransplantation year. In conclusion, sirolimus is independently associated with NOD. Given the negative impact of NOD on posttransplantation outcomes, these findings should be confirmed in prospective studies or in meta-analyses of existing trials that involved sirolimus.