目的：評估腎移植術後使用tacrolimus或cyclosporine發生術後糖尿病(posttransplant diabetes mellitus, PTDM)的比率，並探討其相關之危險因素。
方法：回顧性分析2005年1月到2006年3月之間腎臟移植並於中山醫學大學附設醫院接受追蹤治療的病人，於病歷中腎臟移植前沒有糖尿病的患者，腎臟移植後分別使用tacrolimus (TAC)或cyclosporine (CsA)為基礎，均併用類固醇來預防排斥反應，後續追蹤36個月觀察是否被診斷為PTDM；而PTDM的診斷是根據美國糖尿病協會的指導方針。
結果：符合條件有98位受贈者，平均年齡為52.8±10.9歲，51 (52.0%)位為男性。整體PTDM發生比率為36/98 (36.7%)。最初使用的免疫抑制分別為69 (70.4%)位患者是服用TAC，29 (29.6%)位是CsA；PTDM的累積發病率在TAC和CsA治療組，分別為41.8%和20.7% (P=0.04)。在意向性治療分析(intention-to-treat analysis)，接受TAC的病人發生PTDM比例明顯高於使用CsA 的病人(HR = 2.5 [1.034-5.945]；P = 0.042)。用Kaplan-Meier方法顯示，在36個月時沒有出現PTDM的比率為TAC是55.1%，CsA為79.3% (P = 0.035)。其他的獨立危險因素為身體質量指數(body mass index；P = 0.017)和年齡(P = 0.040)。三年的移植腎存活率分別為有PTDM移植患者是94.6%，沒有PTDM移植患者是95.1%。
結論：PTDM的發病率是與TAC使用，受贈者年齡，身體質量指數有關。因此，改變患者生活方式和免疫抑制藥品的調整以減少PTDM之風險。

PURPOSE:
We attempted to estimate the incidence of posttransplant diabetes mellitus (PTDM) among renal transplant recipients treated with tacrolimus (TAC) or cyclosporine (CsA), to determine other risk factors for PTDM, and describe its outcomes.
METHODS:
From January 2005 to March 2006 in Chung Shan Medical University Hospital, we retrospectively analyzed TAC- or CsA-regimen treated kidney transplant recipients who were free of diabetes before transplantation. The patients were with a posttransplant follow-up for 36 months. PTDM was diagnosed according to American Diabetes Association guidelines.
RESULTS:
The mean age was 52.8 years and 51 (52.0%) were male. The initial immunosuppression for 69 (70.4%) patients was TAC and 29 (29.6%) was CsA. PTDM occurred in 36/98 (36.7%) of patients. The cumulative incidence of PTDM was 41.8% and 20.7% for TAC and CsA groups, respectively. In the intention-to-treat analysis, the proportion of patients receiving TAC who developed PTDM was significantly higher than that of CsA (HR = 2.5 [1.03-5.94]; P = 0.042). The Kaplan-Meier method showed that 55.1% patients taking TAC were free of PTDM at 36 months compared with 79.3% taking CsA (P = 0.035). The other independent risk factors were body mass index (BMI; P = 0.017) and age (P = 0.04). Three-year graft survivals were 94.6% for PTDM patients and 95.1% for those without PTDM.
CONCLUSION:
The incidence of PTDM is associated with TAC use, age, and BMI. Therefore, lifestyle modification and adjustment of immunosuppressants seem reasonable to reduce the risk of PTDM.