Tacrolimus Induced Diabetic Ketoacidosis Following Hematopoietic Stem Cell Transplantation


Risk of diabetes mellitus increases after solid organ and hematopoietic stem cell transplantation. Diabetic ketoacidosis has been reported after solid organ transplantation in patients receiving tacrolimus but has rarely been reported after stem cell transplantation. The major risk factors for diabetic ketoacidosis are immunosuppressive drugs used after transplantation. We report here three cases of allogenic stem cell transplant who developed diabetic ketoacidosis while on treatment with tacrolimus. The drug was stopped in all the cases and patients were treated with insulin therapy resulting in complete recovery from diabetic ketoacidosis.

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  1. 1.

    Fortune K, Couriel D (2009) Tacrolimus in hematopoietic stem cell transplantation. Expert Opin Drug Metab Toxicol 5(7):835–841

    Article  CAS  Google Scholar 

  2. 2.

    Koehler MT, Howrie D, Mirro J, Neudorf S et al (1995) FK506 (tacrolimus) in the treatment of steroid-resistant acute graft-versus-host disease in children undergoing bone marrow transplantation. Bone Marrow Transplant 15(6):895–899

    PubMed  CAS  Google Scholar 

  3. 3.

    Kramer BK, Montagnino G, Castillo D et al (2005) Efficacy and safety of tacrolimus compared with cyclosporin A microemulsion in renal transplantation: 2 year follow-up results. Nephrol Dial Transpl 20:968–973

    Article  CAS  Google Scholar 

  4. 4.

    Salvadori M, Bertoni E, Rosati A, Zanazzi M (2003) Post-transplant diabetes mellitus. J Nephrol 16(5):626–634

    PubMed  Google Scholar 

  5. 5.

    Greenspan LC, Gitelman SE, Leung MA et al (2002) Increased incidence in post-transplant diabetes mellitus in children: a case control analysis. Pediatr Nephrol 17:1–5

    Article  Google Scholar 

  6. 6.

    Traggiai C, Stanhope R, Nussey S, Leiper AD (2002) Diabetes mellitus after bone marrow transplantation during childhood. Med Pediatr Oncol 40:128–129

    Article  Google Scholar 

  7. 7.

    Griffith ML, Jagasia M, Jagasia SM (2010) Diabetes mellitus after hematopoietic stem cell transplantation. Endocr Pract 16(4):699–706

    Article  Google Scholar 

  8. 8.

    Solmaz S, Gökgöz Z, Gereklioğlu C et al (2017) Tacrolimus-induced diabetic ketoacidosis after allogeneic bone marrow transplant. Exp Clin Transpl 15(6):702–703

    Google Scholar 

  9. 9.

    Ricordi C, Zeng Y, Alezandro R et al (1991) In vivo effect of FK506 on human pancreatic islets. Transplantation 52:519–522

    Article  CAS  Google Scholar 

  10. 10.

    Duijnhoven EM, Boots JM, Christiaans MH et al (2001) Influence of tacrolimus on glucose metabolism before and after renal transplantation: a prospective study. JASN 12:583–588

    PubMed  CAS  Google Scholar 

  11. 11.

    Jindal RM, Sidner RA, Milgrom ML (1997) Post-transplant diabetes mellitus. The role of immunosuppression. Drug Saf 16(4):242–257

    Article  CAS  Google Scholar 

  12. 12.

    Yoshida EM, Buczkowski AK, Sirrs SM, Elliott TG et al (2000) Post-transplant diabetic ketoacidosis—a possible consequence of immunosuppression with calcineurin inhibiting agents: a case series. Transpl Int 13:69–72

    Article  CAS  Google Scholar 

  13. 13.

    Montori VM, Basu A, Erwin PJ et al (2002) Posttransplantation diabetes: a systematic review of the literature. Diabetes Care 25(3):583–592

    Article  Google Scholar 

  14. 14.

    Naranjo CA, Busto U, Sellers EM et al (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245

    Article  CAS  Google Scholar 

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We are thankful to Ms Bharti for collecting the data.

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Correspondence to Sanjeev Kumar Sharma.

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Sharma, S.K., Doval, D., Khandelwal, V. et al. Tacrolimus Induced Diabetic Ketoacidosis Following Hematopoietic Stem Cell Transplantation. Indian J Hematol Blood Transfus 35, 711–713 (2019). https://doi.org/10.1007/s12288-019-01113-w

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  • Tacrolimus
  • Stem cell transplant
  • Diabetic ketoacidosis