Pretransplant fasting glucose predicts new-onset diabetes after liver transplantation (original) (raw)
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Liver Transplantation, 2007
New-onset diabetes mellitus (NODM) remains a common complication of liver transplantation (LT). We studied incidence and risk factors in 211 French patients who had undergone a primary LT between 6 and 24 months previously. This is a cross-sectional and retrospective multicenter study. Data were collected on consecutive patients at a single routine post-LT consultation. Demographic details, immunosuppressive regimens, familial and personal histories, hepatitis status, and cardiovascular risk were analyzed to compare those who developed NODM (American Diabetes Association/World Health Organization criteria) with the others. The overall incidence of NODM was 22.7%: 24% in tacrolimus (Tac)-treated patients (n ϭ 175; 82.9%) and 16.7% in cyclosporine-treated patients (n ϭ 36; 17.1%). A total of 81% of the cases were diagnosed within 3 months of LT (M3). Among hepatitis C virus (HCV)-infected (HCV(ϩ)) patients, NODM incidence was 41.7% whereas among those patients negative for this virus (HCV(Ϫ)), the incidence was only 18.9% (P ϭ 0.008). In Tac-treated patients, the incidence of NODM in the HCV(ϩ) patients was significantly higher than in the HCV(Ϫ) patients (46.7% and 19.3%, respectively, P ϭ 0.0014). Only 1 of 6 (16.7%) of the HCV(ϩ) patients developed NODM on cyclosporine. Other independent pretransplantation risk factors for NODM included impaired fasting glucose (IFG) and a maximum lifetime body-mass index (BMI) over 25 kg/m 2 . In conclusion, emergence of NODM after LT is related to risk factors that can be detected prior to the graft, like maximum lifetime BMI, IFG, and HCV status. Tac induced a significantly higher incidence of NODM in the HCV(ϩ) compared to the HCV(Ϫ) patients. The treatment should therefore be tailored to the patient's risk especially in case of HCV infection. Liver Transpl 13: 136-144, 2007.
Transplantation Proceedings, 2006
Objectives: Our aim was to identify the diabetic risk profile of new onset diabetes after live donor renal transplantation (NODAT) and its impact on patient and graft survival in Egyptian population. Patient and methods: A retrospective review of 2019 renal allograft recipients has been performed. Risk factors, medical complications, patient and graft survival were analyzed. Results: After a mean follow up period of 8.8 ± 5.8 years, 450 (22.2%) recipients developed NODAT. A 455 post transplantation time matched control recipients without DM was selected. Time table revealed that 50% of NODAT cases discovered during the first 6 months post transplantation. The NODAT recipients were significantly older and obese with higher body mass index. Family history of DM was significantly positive among the NODAT group. Cox's multivariate regression analysis revealed that the older age, positive family history of DM, high BMI, HCV infection and hypercholesterolemia were of significant risk factor. Medical complications were significant in the NODAT group. Patient survival was significantly lower in the NODAT group on the other hand the graft survival was comparable. Conclusion: NODAT does not statistically affect the graft survival. But, NODAT is a major problem endangers the patient life and must be minded to consider such patient as especially at higher risk for diabetic complications.
Hepatitis C–related cirrhosis: A predictor of diabetes after liver transplantation
Hepatology, 2000
suggested to be a risk factor for the development of diabetes mellitus. The aim of our study was to investigate whether the prevalence of diabetes is increased among liver transplant recipients infected with HCV. We compared the prevalence of diabetes among 278 liver transplant recipients whose original cause of liver failure was HCV infection (110 patients), hepatitis B virus infection (HBV; 53 patients), and cholestatic liver disease (CLD; 115 patients). The pretransplantation prevalence of diabetes was higher in the HCV group (29%) compared with the HBV (6%) and CLD (4%) groups (P F .001). The prevalence of diabetes remained higher in the HCV group 1 year after transplantation: 37%, 10%, and 5% in the HCV, HBV, and CLD groups, respectively (P F .001). The cumulative steroid dose during the first year of transplantation was significantly lower in the HCV group compared with the CLD group. Multivariate analysis revealed that HCV-related liver failure (P ؍ .002), pretransplantation diabetes (P F .0001), and male sex (P ؍ .019) were independent predictors of the presence of diabetes 1 year after transplantation. The high prevalence of diabetes persisted in the HCV group, with 41% diabetic at 5 years. The majority of patients with diabetes mellitus (89%) required insulin therapy after transplantation. Patient and graft survival rates were similar among patients with and without diabetes. In conclusion, our study shows that there is a high prevalence of diabetes among liver transplant recipients infected with HCV both before and after transplantation. (HEPATOLOGY 2000;32:87-90.)
Long-term outcomes of liver transplantation: Diabetes mellitus
Liver Transplantation, 2009
Points 1. Despite methodological problems in estimating the true incidence of new-onset diabetes (NODM), it is generally accepted that this is a common complication of liver transplantation (LT), with the mean reported incidence varying between 7% and 30%. 2. The main predictors of post-LT NODM are ethnicity, a family history of diabetes, age Ͼ 45 years, glucose intolerance prior to LT, central obesity, metabolic syndrome, use of corticosteroids over a long period, use of tacrolimus, and hepatitis C infection. 3. NODM is associated with impaired long-term graft function and reduced survival. Diabetes is among the main risk factors for coronary heart disease, cerebrovascular disease, and peripheral occlusive arterial disease in transplant recipients. 4. The management of NODM includes the therapeutic and preventive steps taken in patients with type 2 diabetes. Little information exists on the use of antidiabetic compounds in transplant recipients. Some studies have suggested that LT recipients with NODM may benefit from a conversion to cyclosporine through improved glucose metabolism. Liver Transpl 15:S79-S82, 2009.
Diabetes mellitus after liver transplantation: prevalence and predictive factors
Journal of Hepatology, 1996
Aims~Methods: To investigate the prevalence and risk factors for the development of diabetes mellitus after orthotopic liver transplantation, we reviewed 27 variables (including previous history of diabetes mellitus, data related to pre-transplant liver disease, and postoperative events) in 102 patients who survived longer than 1 year after orthotopic liver transplantation. Results: Fourteen patients had diabetes mellitus prior to liver transplantation and all but one were alive 2 and 3 years after transplantation, with all survivors continuing to have diabetes mellitus 1, 2 and 3 years after transplantation. Among the 88 patients wihout pre-transplant diabetes mellitus, the prevalence of post-transplant diabetes mellitus was 27% at 1 year, 9% at 2 years and 7% at 3 years, probably related to a significant reduction in the daily prednisone dose (13+4 mg at 1 year, 7+6 mg at 2 years and 2+4 mg at 3 years, p<0.001). Patients with post-transplant diabetes mellitus 1 year after transplantation had a higher number of rejection episodes during the first postoperative year than those without post-transplant diabetes mellitus (1.5+1.1 vs 1.1+0.7, p<0.05) and also had higher, but not statistically significant, cumulative steroid dose and blood cyclosporine levels. Mortality of patients with post-transplant diabetes mellitus was significantly higher during the second postoperative year in comparison with patients without post-transplant diabetes mellitus: 4/24 vs 2/64 (17% vs 3%; p<0.05). Conclusions: Liver transplantation does not significantly modify pre-transplant diabetes mellitus. Diabetes mellitus frequently develops de novo after liver transplantation, although this complication is usually transient and probably related to immunosuppressive drug administration. The prognosis of patients with post-transplant diabetes mellitus is worse than that of those without this complication.
Journal of Korean Medical Science, 2009
Post-transplantation diabetes mellitus (PTDM) is reversible in a considerable number of patients. We examined the prevalence and predictive factors of transient PTDM following liver transplantation. Forty-two of 74 PTDM patients showed the clinical features of transient PTDM. Compared with the persistent PTDM patients, they were characterized by younger age at the time of transplantation (49±7 vs. 53±8 yr, P<0.05), longer time before the development of PTDM (44±59 vs. 13 ±20 days, P<0.05), lower rate of hepatitis c virus seropositivity (0.0 vs. 9.4%, P< 0.05), and use of mycophenolate mofetil (59.5 vs. 28.1%, P<0.05). Among these risk factors, age at the time of transplantation is the single independent predictive factor associated with the reversibility of PTDM.
The American Journal of Surgery, 2005
Background: Recent evidence suggests that new-onset diabetes after transplant (NODAT) adversely affects orthotopic liver transplant (OLTX) patient and graft survival. The objective of this study is to evaluate the effect of hepatitis C infection on the natural history of NODAT. Methods: A retrospective review of 492 OLTX recipients at a single center was conducted from January 1993 to January 2003. Patients were followed for a minimum of 12 months (range 12 months-10 years). The study population consisted of 444 OLTX recipients who were either HCV positive (n ϭ 206) or HCV negative (n ϭ 238). NODAT was defined by the need for antidiabetic medication for at least 7 days starting anytime after OLTX. Statistical analysis was performed by using the Student t test, Kaplan-Meier survival, and chi-square tests. Results: The overall incidence of NODAT was 33% (146/444). There was a significant difference in the development of NODAT between the HCV-positive group (82/206, 40%) and the HCV-negative group (64/238, 27%) (P Ͻ .001). Other independent risk factors for development of NODAT were male gender and age Ͼ50 years. Conclusion: Hepatitis C infection contributes to the development of diabetes mellitus in OLTX recipients. The mechanisms behind HCV infection and associated NODAT in HCV-positive OLTX recipients warrant further investigation.
Journal of transplantation, 2013
New onset diabetes after transplantation (NODAT) occurs less frequently in living donor liver transplant (LDLT) recipients than in deceased donor liver transplant (DDLT) recipients. The aim of this study was to compare the incidence and predictive factors for NODAT in LDLT versus DDLT recipients. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed from 2004 to 2010, and 902 LDLT and 19,582 DDLT nondiabetic recipients were included. The overall incidence of NODAT was 12.2% at 1 year after liver transplantation. At 1, 3, and 5 years after transplant, the incidence of NODAT in LDLT recipients was 7.4, 2.1, and 2.6%, respectively, compared to 12.5, 3.4, and 1.9%, respectively, in DDLT recipients. LDLT recipients have a lower risk of NODAT compared to DDLT recipients (hazard ratio = 0.63 (0.52-0.75), P < 0.001). Predictors for NODAT in LDLT recipients were hepatitis C (HCV) and treated acute cellular rejection (ACR). Risk factors in DDLT...