Diabetes Mellitus Increases the Risk of Mortality Following Liver Transplantation Independent of MELD Score
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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.