Posttransplant Diabetes Mellitus in Liver Transplant Recipients: Risk Factors, Temporal Relationship With Hepatitis C Virus Allograft Hepatitis, and Impact on Mortality1

Abstract

We found a high prevalence of PTDM in HCV (+) recipients. PTDM after OLT was associated with significantly increased mortality. HCV infection and methylprednisolone boluses were found to be independent risk factors for the development of PTDM. In approximately half of the HCV (+) patients with PTDM, the onset of PTDM was related to the recurrence of allograft hepatitis. Improvement in glycemic control was achieved in the patients who responded to antiviral therapy.

Effect of acute and chronic treatment of Cyclosporin A on liver and kidney functions in rats

“…The hypothesis of these nephrotoxicity as indicated in the present study, has been proposed that CsA alters the balance between vasodilators and vasoconstrictors in kidney with predominance of vasoconstrictors and vascular smooth muscle cells proliferation in the intima and accumulation of cholesterol esters in macrophages that can be transformed in foam cells in vessel wall with narrowing of vessel lumen (Beckman et al, 2002). Several studies indicate that vascular dysfunction induced by CsA results from an increase in vasoconstrictor factors such as endothelin, thromboxane, and angiotensin II and at the same time a reduction of vasodilator factors such as prostacyclin and nitric oxide (NO) (Parra et al, 1998;Markell et al, 1994;Bilchick et al, 2004;Baid et al, 2001;Halliwell and Gutteridge, 1999). Therefore, an imbalance in the release of vasoactive substances is related to renal vasoconstriction.…”

New-Onset Diabetes after Transplant (NODAT)

“…Potential mechanisms for the diabetogenic effect of HCV infection include insulin resistance; decreased hepatic glucose uptake and glycogenesis; and direct cytopathic effect of the virus on pancreatic cells. 28 Baid and colleagues 29 have shown that the presence of HCV infection was independently associated with a 62% increase in insulin resistance (P = 0.0005). New onset diabetes after transplantation 10 …”

New Onset Diabetes After Solid Organ Transplantation

“…New onset diabetes mellitus after transplantation has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, 4% to 40% of heart transplant recipients, and 30% to 35% of lung transplant recipients (Baid et al, 2001;Davidson et al, 2003;Knobler et al, 1998;Ye et al, 2010a). There has been scant literature on the incidence of diabetes mellitus after a successful pancreas transplant.…”

“…In HCVinfected liver recipients, the prevalence of NODAT has been reported to range between 40% to 60% (Baid et al, 2001;Bigam et al, 2000;Knobler et al, 1998). While the prevalence of diabetes reported to the International Society of Heart Lung Transplant (ISHLT) are 19% at 1-year and 28% at 5 years for lung transplant recipients, and 15.4% at 1-year and 20% at 5-years for heart-lung transplant recipients (Trulock et al, 2007), a lower prevalence has been reported (Silverborn et al, 2005).…”

“…Independent investigators have shown a temporal relationship between recurrent allograft hepatitis and increasing viral loads and the development of NODAT (Baid et al, 2001;Delgado-Borrego et al, 2004). Furthermore, patients who responded to antiviral therapy were observed to have improvement in glycemic control (Baid et al, 2001;Delgado-Borrego et al, 2004;Simo et al, 2006). In a small cohort of 17 non-diabetic HCV (+) and 33 non-diabetic HCV (-) OLT recipients, Baid and colleagues have shown that the presence of HCV infection was independently associated with a 62% increase in insulin resistance (P=0.0005) (Baid et al, 2001).…”