Incidence and risk factors for new‐onset diabetes in living‐donor liver transplant recipients

Abstract

With the increased number of long-term survivors after liver transplantation, new-onset diabetes after transplantation (NODAT) is becoming more significant in patient follow-up. However, the incidence of new-onset diabetes after living-donor liver transplantation (LDLT) has not been well elucidated. The aim of this study was to evaluate the incidence and risk factors for NODAT in adult LDLT recipients at a single center in Japan. A retrospective study was performed on 161 adult patients without diabetes who had been followed up for ≥three months after LDLT. NODAT was defined according to the 2003 American Diabetes Association/World Health Organization guidelines. The recipient-, donor-, operation-, and immunosuppression-associated risk factors for NODAT were assessed. Overall, the incidence of NODAT was 13.7% (22/161) with a mean follow-up of 49.8 months. In a multivariate analysis, the identified risk factors for NODAT were donor liver-to-spleen (L-S) ratio (hazard ratio [HR] = 0.022, 95% confidence interval [CI] = 0.001-0.500, p = 0.017), and steroid pulse therapy for acute rejection (HR = 3.320, 95% CI = 1.365-8.075, p = 0.008). In conclusion, donor L-S ratio and steroid pulse therapy for acute rejection were independent predictors for NODAT in LDLT recipients. These findings can help in screening for NODAT and applying early interventions.

New‐onset diabetes after liver transplantation and its impact on complications and patient survival

“…Studies have also found that withdrawal of glucocorticoids after renal transplantation may slightly reduce the risk of NODAT, but places transplant patients at risk of AR . However, meta‐analyses on liver transplantation found that withdrawal of glucocorticoids after liver transplantation may reduce the risk of NODAT, whereas no unfavorable effects were observed after steroid withdrawal over short‐term follow up . In the present study, most patients stopped using glucocorticoids within 3 months after transplantation, and there was no difference in the total doses between the NODAT and N‐NODAT groups.…”

Risk Factors of Metabolic Disorders After Liver Transplantation

“…However, study results regarding glucose metabolism remain difficult to compare, mainly because of different definitions of DM, although some of the recent studies also used ADA criteria. 12,[20][21][22] By means of standardized criteria, comparable study results could be obtained which may help to identify independent risk factors for postoperative DM and therefore may lead to early detection of patients at risk and improved postoperative treatment. This should be taken into account in future studies.…”

Sustained Posttransplantation Diabetes Is Associated With Long-Term Major Cardiovascular Events Following Liver Transplantation

“…(8,9) Risk factors for PTDM include older age at transplant, male gender, African-American race, Hispanic ethnicity, chronic hepatitis C infection, NAFLD, tacrolimus use, weight gain after LT, and acute graft rejection. (4,8–10) Diabetes mellitus (DM) in the post-transplant setting has previously been identified as an independent predictor of mortality, diminished graft survival, and post-transplant cardiovascular events.…”

“…(8,9) Risk factors for PTDM include older age at transplant, male gender, African-American race, Hispanic ethnicity, chronic hepatitis C infection, NAFLD, tacrolimus use, weight gain after LT, and acute graft rejection. (4,8–10) Diabetes mellitus (DM) in the post-transplant setting has previously been identified as an independent predictor of mortality, diminished graft survival, and post-transplant cardiovascular events. (11–13) However, many prior investigations of the prognostic impact of PTDM and risk factors for post-LT CVD did not distinguish de novo PTDM from pre-LT DM persisting after LT or further subdivide PTDM into transient and sustained forms.…”