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Journal of Case Reports
Post-transplant Diabetes Mellitus: Immunosuppressive Agent Adjustment and Outcome
Jennie Dianita Sutantio, Bambang Tridjaja Asmara Apri Parwoto, Eka Laksmi Hidayati
Department of Child Health, Faculty of Medicine, Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Corresponding Author:
Dr. Jennie Dianita Sutantio
Email: pediatric.jennie@gmail.com
Received: 12-SEP-2019 Accepted: 19-NOV-2019 Published Online: 05-DEC-2019
DOI: http://dx.doi.org/10.17659/01.2019.0066
Background: Pediatric kidney transplant procedure in Indonesia has been done since 2013 and the case of post-transplant diabetes mellitus (PTDM) was reported in one patient. Challenges had been found in management area, especially in the art of immunosuppressive drugs adjustment and the risk of graft rejection. Case Report: We present a 15-year-old girl with end-stage renal disease who was brought to hospital with hyperglycemia two months after kidney transplantation. She was diagnosed with PTDM due to immunosuppressive agents (basiliximab, tacrolimus and methyl-prednisolone) and received intravenous continuous insulin, followed by basal-bolus regimen. The dosage of her immunosuppressive drugs was decreased gradually, while monitoring her kidney function and tacrolimus level. Her blood glucose improved within three months. She developed complete remission and insulin was no longer used nine months after firstly diagnosed. Conclusion: Gradual reduction of diabetogenic immunosuppressive agents should be done carefully to achieve PTDM remission while maintaining glucose control, targeted blood level of the agents and adequate kidney function.  
Keywords : Diabetes Mellitus, Indonesia, Insulin, Kidney Failure, Kidney Transplantation.
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