The impact of preexisting and post-transplant diabetes mellitus on outcomes following liver transplantation

Aravinthan, Aloysious D; Fateen, Waleed; Doyle, Adam C; Venkatachalapathy, Suresh V; Issachar, Assaf; Galvin, Zita; Sapisochin, Gonzalo; Cattral, Mark S; Ghanekar, Anand; Mcgilvray, Ian D; Selzner, Markus; Grant, David R; Greig, Paul D; Selzner, Nazia; Lilly, Leslie B; Renner, Eberhard L; Bhat, Mamatha

Abstract

Background: Diabetes mellitus (DM) is said to adversely affect transplant outcomes. The aim of this study was to investigate the impact of pre-existing and post-transplant DM on liver transplant (LT) recipients.
Method: A single centre retrospective analysis of prospectively collected data of LT recipients (1990–2015) was undertaken.
Results: Of the 2,209 patients, 13% (n=298) had Pre-DM, 16% (n=362) developed PTDM, 5% (n=118) developed transient hyperglycemia (t-HG) post-LT, and 65% (n=1,431) never developed DM (no DM). Baseline clinical characteristics of patients with PTDM was similar to that of patients with pre-DM. Incidence of PTDM peaked during first-year (87%) and plateaued thereafter. On multivariate analysis (Bonferroni-corrected), non-alcoholic fatty liver disease and the use of Tacrolimus and Sirolimus use were independently associated with PTDM development. Both Pre-DM and PTDM patients had satisfactory and comparable glycaemic control throughout the follow-up period. Those who developed t-HG seems to have a unique characteristic compared to others. Overall, 9%, 5%, and 8% developed end-stage renal disease (ESRD), major cardiovascular event (mCVE), and de novo cancer, respectively. Both Pre-DM and PTDM did not adversely affect patient survival, re-LT, or de novo cancer. The risks of ESRD and mCVE were significantly higher in patients with Pre-DM followed by PTDM and no DM.
Conclusions: In this largest non-registry study, patients with pre-DM and PTDM share similar baseline clinical characteristics. Pre-DM increases the risk of ESRD and mCVE; however, patient survival was comparable to those with PTDM and without diabetes. Understanding the impact of PTDM would need prolonged follow-up.

Citation

Aravinthan, A. D., Fateen, W., Doyle, A. C., Venkatachalapathy, S. V., Issachar, A., Galvin, Z., Sapisochin, G., Cattral, M. S., Ghanekar, A., Mcgilvray, I. D., Selzner, M., Grant, D. R., Greig, P. D., Selzner, N., Lilly, L. B., Renner, E. L., & Bhat, M. (2019). The impact of preexisting and post-transplant diabetes mellitus on outcomes following liver transplantation. Transplantation, 103(12), 2523-2530. https://doi.org/10.1097/TP.0000000000002757

• Journal Article Type: Article
• Acceptance Date: Mar 27, 2019
• Online Publication Date: Apr 10, 2019
• Publication Date: 2019-12
• Deposit Date: Apr 15, 2019
• Publicly Available Date: Apr 11, 2020
• Journal: Transplantation
• Print ISSN: 0041-1337
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 103
• Issue: 12
• Pages: 2523-2530
• DOI: https://doi.org/10.1097/TP.0000000000002757
• Public URL: https://nottingham-repository.worktribe.com/output/1799762
• Publisher URL: https://journals.lww.com/transplantjournal/Abstract/2019/12000/The_Impact_of_Preexisting_and_Post_transplant.15.aspx
• Contract Date: Apr 15, 2019