Abstract: Objective To evaluate safety and efficacy of conversion of calcineurin inhibitors (CNI) to sirolimus (SRL) therapy for
treatment of new-onset diabetes after kidney transplantation (NODAT). Methods Of 321 kidney transplant recipients, 34
patients who developed NODAT (10.59%) were divided into 3 groups to receive continued CNI therapy at a reduced dose
(group A, 14 cases), sirolimus conversion therapy (group B, 12 cases), or oral hypoglycemic drugs (group C, 12 cases). All the
patients had dietary and exercise therapies, and insulin injections were given in patients with postprandial (2 h) blood glucose
over 14.0 mmol/L. The patients were followed up regularly for 5 years. Results The mean blood glucose level was 13.02±1.74
mol/L upon the diagnosis of NODAT in the 34 patients without significant differences between the 3 groups. At 6 months of
therapy, fasting plasma glucose levels in the 3 groups decreased to 8.05 ±2.45, 7.45±2.44, and 9.30±3.89 mmol/L, repsrectively; at
12 months, blood glucose became normal in both groups A and B, but the patients in group A needed a greater daily insulin
dose (P<0.05). In group B, the mean serum creatinine level was 165.1±61.82 mmol/L at the conversion and lowered to 150±53.05
mmol/L at 5 years (P<0.05), which were similar to those in group A at the two time points (152±43.05 and 145.88±53.05 mmol/L,
respectively; P>0.05). In group C, creatinine level further increased after medication with oral hypoglycemic drugs. At 5 years,
the patient and graft survival rates were 100% and 75% in group A, respectively, similar to those in group B (83.4% and 68%,
respectively; P>0.05); group C showed lower patient and graft survival rates than groups B and C. Conclusion Conversion
from CNI to SLR therapy can significantly the metabolism of patients with NODAT without increasing the risk of acute graft
rejection.