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New-onset diabetes mellitus (NODM) remains a common complication of liver transplantation (LT). We studied incidence and risk factors in 211 French patients who had undergone a primary LT between 6 and 24 months previously. This is a cross-sectional and retrospective multicenter study. Data were collected on consecutive patients at a single routine post-LT consultation. Demographic details, immunosuppressive regimens, familial and personal histories, hepatitis status, and cardiovascular risk were analyzed to compare those who developed NODM (American Diabetes Association/World Health Organization criteria) with the others. The overall incidence of NODM was 22.7%: 24% in tacrolimus (Tac)-treated patients (n ϭ 175; 82.9%) and 16.7% in cyclosporine-treated patients (n ϭ 36; 17.1%). A total of 81% of the cases were diagnosed within 3 months of LT (M3). Among hepatitis C virus (HCV)-infected (HCV(ϩ)) patients, NODM incidence was 41.7% whereas among those patients negative for this virus (HCV(Ϫ)), the incidence was only 18.9% (P ϭ 0.008). In Tac-treated patients, the incidence of NODM in the HCV(ϩ) patients was significantly higher than in the HCV(Ϫ) patients (46.7% and 19.3%, respectively, P ϭ 0.0014). Only 1 of 6 (16.7%) of the HCV(ϩ) patients developed NODM on cyclosporine. Other independent pretransplantation risk factors for NODM included impaired fasting glucose (IFG) and a maximum lifetime body-mass index (BMI) over 25 kg/m 2 . In conclusion, emergence of NODM after LT is related to risk factors that can be detected prior to the graft, like maximum lifetime BMI, IFG, and HCV status. Tac induced a significantly higher incidence of NODM in the HCV(ϩ) compared to the HCV(Ϫ) patients. The treatment should therefore be tailored to the patient's risk especially in case of HCV infection. Liver Transpl 13:136-144, 2007.

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First, to evaluate the performance level of a new TSH binding inhibitory antibody assay using human recombinant TSH receptors (h-TBII) in comparison with a thyroid stimulating antibody (TSAb) bioassay performed before, at the end of treatment (18 months) and after antithyroid drug withdrawal in Graves' disease patients; second, to assess the accuracy with which h-TBII levels could predict relapse and remission. Retrospective study on serum samples of Graves' disease patients treated by antithyroid drugs for 18 months. Serum samples from 140 patients (27 men and 113 women; median age 42 years) with recent onset hyperthyroidism due to Graves' disease were retrospectively tested for h-TBII at diagnosis, at 18 months and for 76 of them 6, 12, 24 and 36 months after drug withdrawal or at relapse. TSAb were also evaluated at each time. Thyroid blocking antibodies (TBAb) were measured in sera positive for h-TBII and negative for TSAb. h-TBII levels were measured with a radioreceptor assay using the human recombinant TSH receptor (DYNOtest TRAK human from B.R.A.H.M.S. Diagnostica, Berlin, Germany). TSAb and TBAb levels were assayed in thyrocyte cultures. At diagnosis, high levels of h-TBII were found in 138 of 140 patients with Graves' disease (98.6%). High TSAb values were also detected in the same 138 patients. The h-TBII and TSAb values were significantly correlated (r = 0.582, p < 0.0001). At 18 months, h-TBII were found in 48 of the 140 patients (34%) and TSAb in 43 patients (31%). The h-TBII and TSAb values were significantly correlated (r = 0.618, p < 0.0001) and fell significantly between diagnosis and 18 months (Z = - 9.84, p < 0.0001 and Z = - 9.19, p < 0.0001). TBAb were found in two of the 11 sera positive for h-TBII and negative for TSAb. At diagnosis, the median levels of h-TBII and TSAb were not significantly different between the patients who relapsed within the 3 years after the withdrawal of treatment (n = 60) and those who did not (n = 80) (Z = - 1.1, ns; Z = - 0.216, ns). At 18 months, the prevalences of h-TBII and TSAb were significantly increased in patients who relapsed compared to those who remained in remission at 3 years (60% vs. 15%, chi2 = 30.8, p < 0.0001 and 55% vs. 13%, chi2 = 29.1, p < 0.0001, respectively). h-TBII and TSAb median levels were also significantly increased in patients who relapsed compared to the others (Z = - 4,8, p < 0.0001; Z = - 3,01, P < 0.005). Among the 60 patients who relapsed, 36 (60%) displayed h-TBII and 33 (55%) TSAb at 18 months. The majority of patients who relapsed during the 2 years following the end of treatment, in contrast to those who relapsed later, were positive for h-TBII (67% vs. 27%, chi2 = 6.01, p = 0.035). Seventeen of the 18 tested patients who relapsed were negative for h-TBII at 18 months, were then positive for h-TBII at the time of relapse, whereas 15 of them were still negative, 6-12 months before the relapse. Among the 80 patients who remained in remission at 3 years, only 10 (13%) displayed TSAb and 12 (15%) h-TBII at 18 months. In 10 of th...

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Treatment duration greater than 18 months did not improve remission rate determined 2 years after treatment withdrawal or immunological variables or early iodine uptake measured at the time of discontinuation of treatment. These findings would indicate that, when a defined duration treatment is planned, prolonging treatment beyond 18 months does not provide any additional benefit.

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