Abstract
Background
Patients with diabetes mellitus overall experience worse health outcomes than non-diabetics, but whether this is true among recipients of liver transplantation still remains unclear. The aim of this study was to compare the mortality of diabetic and non-diabetic patients following liver transplantation.
Methods
We conducted a retrospective analysis of 530 adult patients undergoing liver transplantation at Stanford University Medical Center from February 1995 to July 2006. Information on diabetes mellitus was available for 431 patients; 96 patients who had acute liver failure (n = 17), combined liver and kidney transplantation (n = 28), or died prior to discharge (n = 51) were excluded from analysis.
Results
Over a mean follow-up of 4.5 years, survival was 81% in the diabetic group and 94% among controls (p = <0.0001). After controlling for age (mean ± SD: 54.4 ± 7.6 in diabetics, 50.1 ± 9.6 in controls), body mass index (28.6 ± 6.6 in diabetics, 27.1 ± 5.4 in controls), presence of hepatitis C, and MELD score (17 ± 9.6 in diabetics, 19 ± 10.2 in controls), diabetes mellitus remained a significant predictor of death (HR 3.11, p = 0.01).
Conclusions
Diabetes mellitus is an independent risk factor for mortality following liver transplantation. Further investigation of this relationship should focus on the impact of more intensive pre- and post-liver transplantation glucose control, cardiovascular risk factor reduction, and the effects of accelerated atherosclerosis in the setting of immune suppression.
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References
Annual report of the U.S. Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: transplant data 1997–2006. Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation, Rockville, MD; 2007.
Kashyap A, Jain J, Demetris K, et al. Causes of death after liver transplantation in 4000 consecutive patients: 2 to 19 year follow-up. Transplant Proc. 2001;33:1482–1483.
CDC. National Diabetes Fact Sheet: general information and national estimates on diabetes in the United States, 2005. Available at: http://www.cdc.gov/diabetes/pubs/factsheet05.htm. Last accessed: March 2, 2008.
Petrides AS, Vogt C, Schulze-Berge D, Matthews DE, Strohmeyer G. Pathogenesis of glucose intolerance and diabetes mellitus in cirrhosis. Hepatology. 1994;19:616–627.
Zein NN, Abdulkarim AS, Wiesner RH, Egan KS, Persing DH. Prevalence of diabetes mellitus in patients with end-stage liver cirrhosis due to hepatitis C, alcohol, or cholestatic disease. J Hepatol. 2000;32:209–217.
Shintani Y, Fujie H, Miyoshi H, et al. Hepatitis C virus infection and diabetes: direct involvement of the virus in the development of insulin resistance. Gastroenterology. 2004;126:840–848.
Shah T, Kasravi A, Huang E, et al. Risk factors for development of new-onset diabetes mellitus after kidney transplantation. Transplantation. 2006;82:1673–1676.
van Hooff JP, Christiaans MHL, van Duijnhoven EM. Tacrolimus and posttransplant diabetes mellitus in renal transplantation. Transplantation. 2005;79:1465–1469.
Weir MW, Fink JC. Risk for posttransplant diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis. 1999;34:1–13.
Markell M. Clinical impact of posttransplant diabetes mellitus. Transplantation Proc. 2001;33(5A Suppl):19S–22S.
Wilson RM. Neutrophil function in diabetes. Diabet Med. 1986;3:509–512.
Nair S, Verma S, Thuluvath PJ. Obesity and its effect on survival in patients undergoing orthotopic liver transplantation in the United States. Hepatology. 2002;35:105–109.
Menon KVN, Nyberg SL, Harmsen WS, et al. MELD and other factors associated with survival after liver transplantation. Am J Transplant. 2004;4:819–825.
Wahlstrom HE, Cooper J, Gores G, Rosen C, Wiesner R, Krom RAF. Survival after liver transplantation in diabetics. Transplant Proc. 1991;23:1565–1566.
Trail KC, Stratta RJ, Larsen JL, et al. Results of liver transplantation in diabetic recipients. Surgery. 1993;114:650–658.
Shields PL, Tang H, Neuberger JM, Gunson BK, McMaster P, Pirenne J. Poor outcome in patients with diabetes mellitus undergoing liver transplantation. Transplantation. 1999;68:530–535.
Blanco JJ, Herrero JI, Quiroga J, et al. Liver transplantation in cirrhotic patients with diabetes mellitus: midterm results, survival, and adverse events. Liver Transpl. 2001;7:226–233.
John PR, Thuluvath PJ. Outcome of liver transplantation in patients with diabetes mellitus: a case control study. Hepatology. 2001;34:799–895.
Yoo HY, Thuluvath PJ. The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation. Transplantation. 2002;74:1007–1012.
Velidedeoglu E, Mange KC, Frank A, et al. Factors differentially correlated with the outcome of liver transplantation in HCV+ and HCV− recipients. Transplantation. 2004;77:1834–1842.
Saab S, Wang V, Ibrahim A, et al. MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl. 2003;9:473–476.
Habib A, Berk B, Chang C, et al. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12:440–447.
Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917–932.
Pinhas-Hamiel O, Zeitler P. The global spread of type II diabetes mellitus in children and adolescents. J Pediatr. 2005;146:693–700.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–1053.
Thuluvath PJ. When is diabetes mellitus a relative or absolute contraindication to liver transplantation? Liver Transpl. 2005;11(suppl):S25–S29.
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Samuelson, A.L., Lee, M., Kamal, A. et al. Diabetes Mellitus Increases the Risk of Mortality Following Liver Transplantation Independent of MELD Score. Dig Dis Sci 55, 2089–2094 (2010). https://doi.org/10.1007/s10620-010-1267-5
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DOI: https://doi.org/10.1007/s10620-010-1267-5