Risk Factors Associated With New-Onset Diabetes After Liver Transplant: A Case Control Study

Terto, Stephanie Veras; Araújo, Samila Torquato; Negreiros, Francisca Diana da Silva; Brasil, Bruna Michelle Belém Leite; Cunha, Gilmara Holanda da; Rodrigues, Andrea Bezerra; Carvalho, Michelle Garcêz de; Gadelha, Daniel Duarte; Carioca, Antônio Augusto Ferreira; Fernandes, Virgínia Oliveira; Júnior, Renan Magalhães Montenegro

doi:10.1016/j.transproceed.2019.04.030

Cited by 8 publications

(4 citation statements)

References 16 publications

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“…Living donor transplant (HR =0.628) and induction therapy (HR =0.816) were associated with a decreased risk of NODM (35). Case-control study by Terto et al illustrated that pre-existing systemic arterial hypertension and immunosuppression (sodium mycophenolate and tacrolimus) increased the risk of new-onset diabetes after transplant (36). NODM results in increased susceptibility to infectious and CV complications, may lead to reduced longterm graft survival, and has a major impact on the quality of life and survival (37,38).…”

Section: Post-lt Obesitymentioning

confidence: 99%

Bariatric surgery, obesity and liver transplantation

Ahmed¹,

Khan²,

Vazquez‐Montesino³

et al. 2022

Transl Gastroenterol Hepatol

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Section: Post-lt Obesitymentioning

confidence: 99%

Bariatric surgery, obesity and liver transplantation

Ahmed¹,

Khan²,

Vazquez‐Montesino³

et al. 2022

Transl Gastroenterol Hepatol

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“…A case-control study conducted by Terto et al found that TAC, being the most common maintenance immunosuppressive agent used PT, was significantly associated with the emergence of NODALT during a mean time of five months PT [ 37 ]. Furthermore, Song and his colleagues went in-depth and assessed the blood concentration of tacrolimus (cTAC) systematically and established a significant relationship between the mean trough cTAC on the sixth-month PT and the onset of NODALT in two different studies with similar results.…”

Section: Reviewmentioning

confidence: 99%

New-Onset Diabetes Mellitus (NODM) After Liver Transplantation (LT): The Ultimate Non-diabetogenic Immunosuppressive Therapy

Chaitou¹,

Valmiki²,

Valmiki³

et al. 2022

Cureus

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New-onset diabetes mellitus (NODM) is a common long-term complication after liver transplantation (LT). It is thought to be drug-induced in most cases, no matter the underlying disease that cause liver failure and indicated transplantation. Standard post-transplantation (PT) immunosuppressive regimens include prolonged use of calcineurin inhibitors (CNIs), namely tacrolimus (TAC), alongside corticosteroids to avoid acute and chronic graft rejection. This combination is well known for its diabetogenicity. Significant differences between the applied regimens stand out concerning the duration and dosages to prevent the metabolic side effects of these drugs in the long run without compromising the graft's survival. Studies were collected after an extensive research of PubMed database for this very specific topic using the following MeSH keywords in multiple combinations: "Liver Transplantation," "Diabetes Mellitus," "NODM," "Tacrolimus," "Cyclosporine A," and "Steroids." In addition, we used the same keywords for regular searches in Google Scholar. Only the relevant English human studies between 2010 and 2020 were collected except for review articles. Duplicates were eliminated using Mendeley software. Twelve relevant studies directly related to the targeted topic were collected and discussed, including five retrospective cohorts, four prospective cohorts, one clinical trial, one prospective pilot, and one case report. Their topics included primarily the factors increasing the risk of new-onset diabetes mellitus after liver transplantation (NODALT), TAC-based immunosuppression and its relative blood levels affecting the possible development of NODALT, the role of cyclosporine in substituting TAC regimen, and the effect of different steroids-avoiding protocols on the prevention of NODALT. The reviewed studies suggested that lowering the serum concentration of tacrolimus (cTAC) throughout the PT period and eliminating the corticosteroids regimen as early as possible, among other measures, can significantly impact the rate of emergence of NODM. This traditional review tackles the most recent studies about NODALT to establish a comprehensive view on this issue and guide clinicians and researchers for the safest immunosuppressive regimen to date, while maintaining a balanced metabolic profile.

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“…Different studies from Western and Asian countries reported a prevalence of PTDM ranging from 8.4% to 40% 138,[145][146][147][148][149][150][151][152] ; this wide variability depends on the diagnostic criteria, risk factors for de novo diabetes, and baseline characteristics. As for general population, risk factors are Hispanic or African American ethnicity (1.6fold increased risk), 150 male gender, older age, familiarity for diabetes, and metabolic risk factors (perisurgical blood glucose, 148 arterial hypertension, 153 and higher preoperative triglycerides, even within a near-normal range). 154 A recent meta-analysis pooling data from 37 studies showed that pre-LTx body mass index and overweight were associated with a higher risk of PTDM, while no association was found with post-LTx body mass index.…”

Section: Late Hyperglycemiamentioning

confidence: 99%

Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients

et al. 2021

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Diabetes is common in patients waitlisted for liver transplantation because of end-stage liver disease or hepatocellular cancer as well as in posttransplant phase (posttransplantation diabetes mellitus). In both conditions, the presence of diabetes severely affects disease burden and long-term clinical outcomes; careful monitoring and appropriate treatment are pivotal to reduce cardiovascular events and graft and recipients' death. We thoroughly reviewed the epidemiology of diabetes in the transplant setting and the different therapeutic options, from lifestyle intervention to antidiabetic drug use-including the most recent drug classes available-and to the inclusion of bariatric surgery in the treatment cascade. In waitlisted patients, the old paradigm that insulin should be the treatment of choice in the presence of severe liver dysfunction is no longer valid; novel antidiabetic agents may provide adequate glucose control without the risk of hypoglycemia, also offering cardiovascular protection. The same evidence applies to the posttransplant phase, where oral or injectable noninsulin agents should be considered to treat patients to target, limiting the impact of disease on daily living, without interaction with immunosuppressive regimens. The increasing prevalence of liver disease of metabolic origin (nonalcoholic fatty liver) among liver transplant candidates, also having a higher risk of noncirrhotic hepatocellular cancer, is likely to accelerate the acceptance of new drugs and invasive procedures, as suggested by international guidelines. Intensive lifestyle intervention programs remain however mandatory, both before and after transplantation. Achievement of adequate control is mandatory to increase candidacy, to prevent delisting, and to improve long-term outcomes.

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Risk Factors Associated With New-Onset Diabetes After Liver Transplant: A Case Control Study

Cited by 8 publications

References 16 publications

Bariatric surgery, obesity and liver transplantation

Bariatric surgery, obesity and liver transplantation

New-Onset Diabetes Mellitus (NODM) After Liver Transplantation (LT): The Ultimate Non-diabetogenic Immunosuppressive Therapy

Management of Diabetes in Candidates for Liver Transplantation and in Transplant Recipients

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