Diabetes mellitus after liver transplantation: prevalence and predictive factors

Navasa, Miquel; Bustamante, Javier; Marroni, Cláudio Augusto; González, Eleazar; Andreu, Hernán; Esmatjes, Enric; García‐Valdecasas, Juan Carlos; Grande, Luís; Cirera, Isabel; Rimola, Antoni; Rodés, Joan

doi:10.1016/s0168-8278(96)80329-1

Cited by 139 publications

(118 citation statements)

References 26 publications

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“…Patients with pre-OLT DM not requiring treatment also had a greater incidence of post-OLT DM during the first year, but the difference between these patients and those without DM lost its significance later. Post-OLT DM was very infrequent in patients without DM before OLT, and none of the patients with normal OGTT results had post-OLT DM at any of the times studied (3,12,24, and 36 months). As shown, the incidence of post-OLT DM is greatest in the early post-OLT period, probably because of the greater doses of immunosuppressive drugs used during this period and the persistence of some degree of portasystemic shunting.…”

Section: Discussionmentioning

confidence: 91%

“…Conversely, other studies did not show a difference between patients with and without DM. 12,[14][15][16][17] In these studies, DM had been diagnosed according to serum fasting glucose levels, probably underestimating the incidence of liver cirrhosis-related DM.The aim of this study is to investigate the prevalence of pre-OLT DM in end-stage liver cirrhosis and assess the evolution of patients with DM after OLT. In addition, factors predisposing to post-OLT DM were studied.…”

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confidence: 99%

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Liver transplantation in cirrhotic patients with diabetes mellitus: Midterm results, survival, and adverse events

et al. 2001

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Liver cirrhosis is frequently associated with diabetes mellitus (DM), and this metabolic complication is also frequent after orthotopic liver transplantation (OLT). The aim of our study is to investigate which factors are associated with DM before and after OLT and their impact on post-OLT evolution. We evaluated the prevalence of DM among 115 liver transplant candidates with cirrhosis and assessed their evolution after OLT (median follow-up, 41 months). Sixteen candidates had DM requiring pharmacological therapy (group A), 45 candidates had DM controlled with diet (group B), and 54 candidates did not have DM (group C). One-year and 3-year actuarial survival rates were 100% and 100% for group A, 91% and 85% for group B, and 77% and 74% for group C, respectively (P < .03). Post-OLT DM was more frequent in group A. The incidence of other metabolic complications, major infections, rejection, and arterial hypertension; the need for hospitalization; and renal and graft function of patients in groups A, B, and C were similar. The only risk factor for DM 1 year after OLT on multivariate analysis was pre-OLT DM requiring pharmacological treatment. L iver cirrhosis is frequently associated with impaired glucose metabolism. 1-3 Insulin resistance has been found in most patients with cirrhosis. 4-6 It seems to be caused mainly by a deficiency in insulin-stimulated glycogen synthesis in the muscle. 4 This insulin resistance increases the demand for pancreatic insulin secretion and may lead to overt diabetes mellitus (DM), 7 found in 10% to 30% of the patients with cirrhosis.Glucose intolerance and insulin resistance of patients with cirrhosis are reversed after orthotopic liver transplantation (OLT), 8 but the use of such immunosuppressive drugs as cyclosporine, tacrolimus, or prednisone can alter glucose metabolism either by direct effect on pancreatic ␤-cells or by contributing to insulin resistance. 9-11 Thus, the global effect of OLT on glucose metabolism may be both prodiabetogenic and antidiabetogenic.Some studies have reported the evolution of transplant recipients with DM after OLT. [12][13][14][15][16][17] In 1 study, 13 liver transplant recipients with DM had a lower survival rate than those without DM. Conversely, other studies did not show a difference between patients with and without DM. 12,[14][15][16][17] In these studies, DM had been diagnosed according to serum fasting glucose levels, probably underestimating the incidence of liver cirrhosis-related DM.The aim of this study is to investigate the prevalence of pre-OLT DM in end-stage liver cirrhosis and assess the evolution of patients with DM after OLT. In addition, factors predisposing to post-OLT DM were studied. Patients and Methods Study Design and PopulationFrom February 1990 to October 1998, a total of 115 adult patients with liver cirrhosis undergoing OLT at a single institution were studied before OLT by means of an oral glucose tolerance test (OGTT) to rule out DM, unless they had a previous reported diagnosis of DM. According to the 1997 recommen...

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Section: Discussionmentioning

confidence: 91%

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confidence: 99%

Liver transplantation in cirrhotic patients with diabetes mellitus: Midterm results, survival, and adverse events

et al. 2001

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“…9,13,40 In addition, the excellent results after OLT will not be maintained with the progression of time because the graft may be reinfected; the long-term immunosuppression is associated with potentially severe side effects that may deteriorate the quality of life and/or make worse the long-term prognosis. [44][45][46][47][48] Because there are no controlled trials comparing OLT against hepatic resection, there is no answer as to which of the two options should be proposed first. In our Unit we still consider surgical resection, although its indication is limited to patients with extremely well preserved liver function and who do not have portal hypertension, as assessed by hepatic venous catheterization.…”

Section: Discussionmentioning

confidence: 99%

Liver transplantation for small hepatocellular carcinoma: The tumor-node-metastasis classification does not have prognostic power

et al. 1998

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From a theoretical point of view, orthotopic liver transplantation (OLT) should be considered the ideal therapeutic option for patients with hepatocellular carcinoma (HCC).This neoplasm usually appears in the setting of liver cirrhosis, 1,2 and thus, OLT would eliminate the tumor and the oncogenic underlying liver. However, the first series of OLT for HCC showed disappointing results. [3][4][5][6] The inclusion of patients with advanced HCC prompted a high recurrence rate (higher than 50% at 3 years) whereas the survival rate (20%-50% at 5 years) was clearly less than that of non-HCC patients. Subsequent reports showed that HCC stage is a key point in determining the success of OLT in these patients and suggested that patients with early HCC could benefit from OLT both in terms of recurrence and survival. 5,7-10 Thereby, the recurrence rate of patients with incidental tumors which were discovered at the time of the pathological examination of the explanted liver is negligible. 3,7 Finally, two recent studies have shown that if OLT is restricted only to patients with early HCC (some years ago these tumors would have been identified only in the explanted livers), the risk of recurrence is minimal and the survival is identical to that of patients without HCC. 11,12 These encouraging data would favor OLT as the first therapeutic option to be considered in patients with HCC 13 as surgical resection is hampered by a higher recurrence rate during follow up [14][15][16][17] ; however, OLT is a highly invasive procedure with potentially severe complications in the early, medium, and long-term follow up. In addition, it must be stressed that HCC in most of the patients arises on liver cirrhosis caused by infection with HBV or HCV, 2,18 which frequently infects the graft, 19,20 and that the progression of the liver disease may be faster than in immunologically competent individuals. 21 As previously reported, 22-25 the treatment schedule applied in our Liver Unit in patients with HCC considered OLT only for those patients with solitary tumors smaller than 5 cm in whom resection was contraindicated, whereas the stage according to the TNM staging system was not taken into account. The present study analyzes the outcome of the cohort of the first 58 HCC patients submitted to OLT following this pre-established treatment algorithm, describing the accuracy of the preoperative staging, the recurrence and survival data, and also the rate of viral infection of the new liver. PATIENTS AND METHODS PatientsBetween January 1989 and December 1995, 877 patients with HCC were diagnosed, staged, and treated in our Liver Unit according to a previously published schedule. [22][23][24][25] Patients with HCC were Abbreviations: HCC, hepatocellular carcinoma; OLT, orthotopic liver transplantation; TNM, tumor-node-metastasis classification system; pTNM, pathological tumor-nodemetastasis classification.From the

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“…21,22 Risk factors for post-OLT diabetes include pretransplant diabetes, obesity, hepatitis C infection, corticosteroids (by inducing insulin resistance, increasing gluconeogenesis, decreasing peripheral insulin utilization), CNIs (through pancreatic ␤-cell toxicity and inducing insulin resistance, commonly thought tacrolimus moreso than cyclosporine, but is controversial), 23 and mammalian target of rapamycin (mTOR) inhibitor use (by inducing insulin resistance, increasing gluconeogenesis, and decreasing peripheral insulin utilization). [21][22][23][24][25] Both pre-and post-OLT diabetes are risk factors associated with higher mortality and morbidity in OLT recipients. 2,26 Post-OLT diabetes not only is associated with the usual microvascular and macrovascular complications but also has a significant impact …”

Section: Diabetesmentioning

confidence: 99%

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

Singh

Watt

2012

Mayo Clinic Proceedings

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Recognition, management, and prevention of medical complications and comorbidities after liver transplant is the key to improved long-term outcomes. Beyond allograft-related complications, metabolic syndrome, cardiovascular disease, renal dysfunction, and malignancies are leading causes of morbidity and mortality in this patient population. Primary care physicians have an important role in improving outcomes of liver transplant recipients and are increasingly relied on for managing these complex patients. This review serves to assist the primary care physician in the long-term management issues of liver transplant recipients.

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Diabetes mellitus after liver transplantation: prevalence and predictive factors

Cited by 139 publications

References 26 publications

Liver transplantation in cirrhotic patients with diabetes mellitus: Midterm results, survival, and adverse events

Liver transplantation in cirrhotic patients with diabetes mellitus: Midterm results, survival, and adverse events

Liver transplantation for small hepatocellular carcinoma: The tumor-node-metastasis classification does not have prognostic power

Long-term Medical Management of the Liver Transplant Recipient: What the Primary Care Physician Needs to Know

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