New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database

Abstract

New onset diabetes after transplantation (NODAT) occurs less frequently in living donor liver transplant (LDLT) recipients than in deceased donor liver transplant (DDLT) recipients. The aim of this study was to compare the incidence and predictive factors for NODAT in LDLT versus DDLT recipients. The Organ Procurement and Transplant Network/United Network for Organ Sharing database was reviewed from 2004 to 2010, and 902 LDLT and 19,582 DDLT nondiabetic recipients were included. The overall incidence of NODAT was 12.2% at 1 year after liver transplantation. At 1, 3, and 5 years after transplant, the incidence of NODAT in LDLT recipients was 7.4, 2.1, and 2.6%, respectively, compared to 12.5, 3.4, and 1.9%, respectively, in DDLT recipients. LDLT recipients have a lower risk of NODAT compared to DDLT recipients (hazard ratio = 0.63 (0.52–0.75), P < 0.001). Predictors for NODAT in LDLT recipients were hepatitis C (HCV) and treated acute cellular rejection (ACR). Risk factors in DDLT recipients were recipient male gender, recipient age, body mass index, donor age, donor diabetes, HCV, and treated ACR. LDLT recipients have a lower incidence and fewer risk factors for NODAT compared to DDLT recipients. Early identification of risk factors will assist timely clinical interventions to prevent NODAT complications.

Prevalence and risk factors of obesity, hypertension, dyslipidemia and diabetes mellitus before and after adult living donor liver transplantation

“…Moreover, each criterion for diagnosis of the individual components is different from that of MS. The prevalence and risk factors of the individual components of MS in living donor LTx recipients was reported previously, but the correlation among all components was rarely reported. In this study, we analyzed the prevalence and risk factors of obesity, hypertension, dyslipidemia and DM, as diagnosed by the criteria of the Japan Societies, before and after adult living donor LTx.…”

Liver Transplantation: the Role of Metabolic Syndrome

“…A recent meta-analysis linked to HCV infection, male sex, family history of T2DM, tacrolimus use, BMI, and impaired fasting glucose with increased risk of NODAT [106]. Grafts received from donors after circulatory death have been linked to higher incidences of NODAT when compared with living donor recipients, perhaps related to donor factors such as sex, BMI, age, HCV status, and warm ischemia time [107]. NODAT is associated with increased risk of cardiac, renal, infectious, neurologic, and neuropsychiatric complications and reduced patient and graft survival [108,109].…”

Hyperglycemia During the Immediate Period Following Liver Transplantation

“…Potential risk factors associated with NODAT include the conventional risk factors for Type 2 DM, such as race/ethnicity, obesity, family history of DM, increasing age and impaired glucose tolerance pretransplant, but also include use of immunosuppressive medications [1–5]. Among liver transplant recipients, other implicated risk factors include hepatitis C virus infection and receipt of organs from deceased donors [4,6]. …”