Diabetes Mellitus Increases the Risk of Mortality Following Liver Transplantation Independent of MELD Score
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
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).
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.
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- van Hooff JP, Christiaans MHL, van Duijnhoven EM. Tacrolimus and posttransplant diabetes mellitus in renal transplantation. Transplantation. 2005;79:1465–1469. CrossRef
- Weir MW, Fink JC. Risk for posttransplant diabetes mellitus with current immunosuppressive medications. Am J Kidney Dis. 1999;34:1–13. CrossRef
- Markell M. Clinical impact of posttransplant diabetes mellitus. Transplantation Proc. 2001;33(5A Suppl):19S–22S. CrossRef
- Wilson RM. Neutrophil function in diabetes. Diabet Med. 1986;3:509–512. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- 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. CrossRef
- John PR, Thuluvath PJ. Outcome of liver transplantation in patients with diabetes mellitus: a case control study. Hepatology. 2001;34:799–895. CrossRef
- Yoo HY, Thuluvath PJ. The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation. Transplantation. 2002;74:1007–1012. CrossRef
- 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. CrossRef
- 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. CrossRef
- Habib A, Berk B, Chang C, et al. MELD and prediction of post-liver transplantation survival. Liver Transpl. 2006;12:440–447. CrossRef
- Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917–932. CrossRef
- Pinhas-Hamiel O, Zeitler P. The global spread of type II diabetes mellitus in children and adolescents. J Pediatr. 2005;146:693–700. CrossRef
- 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. CrossRef
- Thuluvath PJ. When is diabetes mellitus a relative or absolute contraindication to liver transplantation? Liver Transpl. 2005;11(suppl):S25–S29. CrossRef
- Diabetes Mellitus Increases the Risk of Mortality Following Liver Transplantation Independent of MELD Score
Digestive Diseases and Sciences
Volume 55, Issue 7 , pp 2089-2094
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Liver transplantation
- Diabetes mellitus
- Mortality after transplantation
- Industry Sectors
- Author Affiliations
- 1. Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, 300 Pasteur Drive, Grant S101, Stanford, CA, 94305-5109, USA
- 2. Division of Gastroenterology, Santa Clara Valley Medical Center, 751 South Bascom Avenue, San Jose, CA, 95128, USA