Worsening of hyperglycemia due to atorvastatin in a renal transplant patient

New-onset diabetes mellitus post-renal transplantation [post-transplantation diabetes mellitus (PTDM)] and impaired glucose tolerance are among the most serious adverse metabolic disturbances of kidney transplants. We report a renal transplant patient whose mild post-transplant hyperglycaemia considerably worsened upon substituting atorvastatin for pravastatin. The patient was a 58-years-old Caucasian man who underwent living, non-related kidney transplantation. The mean blood sugar level (BSL) following transplantation was 113.8 mg/dl. In an attempt to reduce LDL cholesterol, atorvastatin 40 mg/day was substituted for pravastatin. Soon after commencement of atorvastatin, polydipsia and polyuria appeared. Both fasting and 2-h post-prandial BSL values increased, while there was no change in the patient's medications, dietary habits and renal function. Upon reverting back to pravastatin, BSL promptly declined to the previously mentioned baseline values. Since PTDM is a strong independent factor of graft failure, cardiovascular events and mortality, physicians should be made aware of this possible adverse effect of atorvastatin on glucose tolerance.