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., …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