New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study

Abstract

Background: New-onset diabetes after transplantation (NODAT) is a serious complication following liver transplantation (LT). The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry (KOTRY) database.Methods: Patients with history of pediatric transplantation (age ≤18 years), re-transplantation, multi-organ transplantation, or pre-existing diabetes mellitus were excluded. A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included. Risk factors were identified using Cox regression analysis. Results: NODAT occurred in 19.7% (n=377) of adult liver transplant recipients. Multivariate analysis showed steroid use, increased age, and high body mass index (BMI) in recipients, and implantation of a leftside liver graft was closely associated with NODAT in adult LT. In living donor liver transplant (LDLT) patients (n=1,473), open donor hepatectomy in the living donors, steroid use, small for size liver graft (graft to recipient weight ratio ≤0.8), increased age, and high BMI in the recipient were predictive factors for NODAT. The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT. Conclusions: Basiliximab induction, early steroid withdrawal, and antimetabolite therapy may prevent NODAT after adult LT. High BMI or advanced age in liver recipients, open donor hepatectomy in living donors, and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT.

Outcomes after liver transplantation in Korea: Incidence and risk factors from Korean transplantation registry

“…We found that pre-transplant obesity (BMI ≥25 kg/m 2 ), use of steroids, and anti-metabolites were associated with a higher risk of NODM post LT. These results are in alignment with recent results published by KOTRY on NODM in the same population [ 40 ].…”

“…These results are in alignment with recent results published by KOTRY on NODM in the same population. 40 In order to improve the outcomes after LT, appropriate surgical technique, donor-recipient matching and optimization of immunosuppressants is essential. Also, there is a need for further research on innovative management strategies such as machine perfusion, liver support device and tissue bioengineering.…”

Changes in blood glucose level after renal transplantation in pediatrics: A study of risk factors of new‐onset diabetes after transplantation

“…In the kidney transplant population, NODAT occurs as a metabolic complication in up to 24% of adults. In children, the incidence has increased from 3% in 2001 as reported by Al‐Uzri et al 6 to 9% in 2009 as reported by Koshy et al 6–8 …”

New onset diabetes mellitus after liver transplantation

“…The recently published article, "New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study" by Man Kim et al has generated significant renewed interest in New Onset Diabetes after Transplant (NODAT) (1). NODAT was defined by International Consensus (2003) and by American Diabetes Association by the same criteria as Type 1/Type 2 diabetes.…”