Impact of obesity and diabetes on waitlist survival, probability of liver transplantation and post‐transplant survival among chronic hepatitis C virus patients

Aguilar, María; Liu, Benny; Holt, Edward W.; Bhuket, Taft; Wong, Robert J.

doi:10.1111/liv.13091

Cited by 14 publications

(19 citation statements)

References 21 publications

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“…Second, T2DM remains a strong risk factor for HCC development in cirrhotics after SVR has been obtained but a good glycemic control seems to reduce the incidence of HCC . Third, pre‐OLT diabetes is associated with increased incidence of post‐OLT mortality; a recent study showed that good glycemic control preoperatively may protect against the harmful effect of T2DM on infection and is associated with a reduced risk of readmission to intensive care unit and a reduced length of stay in hospital.…”

Section: Discussionmentioning

confidence: 99%

Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct‐acting antiviral agents

Ciancio

Bosio

et al. 2017

Journal of Medical Virology

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Many studies showed insulin resistance amelioration in HCV-patients achieving Sustained Virologic Response (SVR) but results on glycemic control in diabetic patients are unclear. This study aimed to assess fasting glucose (FG) and glycated hemoglobin (HbA1c) values before and after therapy with direct-acting antivirals (DAAs) in HCV-patients with type 2 diabetes mellitus (T2DM). Of the 122 consecutively recruited patients with chronic hepatitis C and T2DM, 110 patients were treated with DAAs and 12 remained untreated. Clinical, biochemical, virological, and metabolic features were collected both at baseline and at 12 weeks after the end of therapy (EOT) or after a comparable period of time in untreated patients. A total of 101 patients obtained a SVR (Group 1), while nine were relapsers. Group 2 (21 patients) was composed by the nine relapsers and the 12 untreated patients. A significant reduction of mean FG (134.3 ± 41.32 mg/dL vs 152.4 ± 56.40 mg/dL, P = 0.002) and HbA1c values (46.51 ± 16.15 mmoL/moL vs 52.15 ± 15.43 mmoL/moL, P < 0.001) was found in Group 1 but not in Group 2 (140.6 ± 47.87 mg/dL vs. 145.31 ± 30.18 mg/dL, P = 0.707, and 55.31 ± 20.58 mmoL/moL vs. 53.38 ± 9.49 mmoL/moL, P = 0.780). In Group 1, 20.7% of patients could reduce or suspend their antidiabetic therapy compared to none in Group 2 (P = 0.03), despite the significant weight increase observed in Group 1. SVR induced a significant amelioration of glycemic control in diabetic HCV-patients, despite a significant weight increase; larger prospective studies are needed to verify whether these results are maintained over the long-term.

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Section: Discussionmentioning

confidence: 99%

Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct‐acting antiviral agents

Ciancio

Bosio

et al. 2017

Journal of Medical Virology

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“…15,16 As a result, the prevalence of obesity in the new LT waitlist registrant population is high. 17,18 However, many transplant programs decline LT to obese candidates 17 because they have a higher risk of perioperative and postoperative complications 19,20 and death 3,4,6,9 than nonobese candidates. Moreover, obese waitlisted candidates have a longer waiting time for LT and the likelihood of receiving a Model for End-Stage Liver Disease (MELD) exception is 30% to 38% lower than normal-weight candidates.…”

mentioning

confidence: 99%

Reexamining the Association of Body Mass Index With Overall Survival Outcomes After Liver Transplantation

Chang

Liu

Carlsson

et al. 2017

Transplantation Direct

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“…Moreover, both for liver and lung transplant, again we find conflicting results when researchers evaluate the influence that diabetes exerts on the short‐term prognosis after the procedure: some reports support a deleterious effect because of hyperglycaemia, whilst others do not …”

Section: Introductionmentioning

confidence: 93%

“…4 Moreover, both for liver and lung transplant, again we find conflicting results when researchers evaluate the influence that diabetes exerts on the short-term prognosis after the procedure: some reports support a deleterious effect because of hyperglycaemia, 5,6 whilst others do not. 7,8 Therefore, we decided to broaden the scope of our previous study to perform a comprehensive analysis of all types of solid organ transplants. We had access to additional data pertaining to 2014 and 2015, unavailable at the time of our previous publication concerning kidney transplant.…”

Section: Introductionmentioning

confidence: 99%

In‐hospital outcomes for solid organ transplants according to type 2 diabetes status: An observational, 15‐year study in Spain

et al. 2018

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Summary Aims To describe trends and outcomes during admission for solid organ transplant in people with or without type 2 diabetes in Spain, 2001‐2015. Methods We used national hospital discharge data to select all hospital admissions for kidney, lung, heart, and liver transplant. We estimated admission rates stratified by type 2 diabetes status. We built Poisson regression models to compare the adjusted time trends in admission rates. We tested in‐hospital mortality (IHM) in logistic regression analyses. Results We identified 50 964 transplants (16.7% in people with type 2 diabetes): kidney, 30 919; lung, 2810; heart, 3649; liver, 13 586. The overall adjusted incidence rate ratios (95% confidence intervals) of admission in people with type 2 diabetes vs no diabetes were 2.4 (2.32‐2.48) for kidney, 1.51 (1.33‐1.70) for lung, 2.87 (2.63‐3.13) for heart, and 4.16 (3.99‐4.33) for liver transplant. In the multivariate analysis, IHM decreased significantly over time for all types of transplant. Type 2 diabetes independently predicted lower IHM during admission only for heart (Odds ratio, OR [95% CI] = 0.62 [0.47‐0.81]) and liver transplant (OR [95% CI] = 0.69 [0.58‐0.82]). Conclusions Admission rates for solid organ transplant were higher in people with type 2 diabetes than in people without diabetes. Type 2 diabetes was associated with lower in‐hospital mortality during admission for heart and liver transplant.

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Impact of obesity and diabetes on waitlist survival, probability of liver transplantation and post‐transplant survival among chronic hepatitis C virus patients

Abstract: Among adults with chronic HCV awaiting LT in the US, obesity is associated with lower probability of receiving LT, but did not impact waitlist survival. DM among chronic HCV patients did not impact waitlist survival or probability of LT.

Cited by 14 publications

References 21 publications

Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct‐acting antiviral agents

Significant improvement of glycemic control in diabetic patients with HCV infection responding to direct‐acting antiviral agents

Reexamining the Association of Body Mass Index With Overall Survival Outcomes After Liver Transplantation

In‐hospital outcomes for solid organ transplants according to type 2 diabetes status: An observational, 15‐year study in Spain

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