The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation

Yoo, Hae Young; Thuluvath, Paul J.

doi:10.1097/00007890-200210150-00019

Cited by 111 publications

(107 citation statements)

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“…Many factors, including age, race, cause of liver disease, United Network for Organ Sharing (UNOS) status, creatinine level, diabetes, obesity, hypertension, and heart disease, influence posttransplantation survival. [5][6][7][8][9][10] Patients who undergo re-LT are more likely to have these risk factors compared with those who undergo PLT.…”

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confidence: 99%

Retransplantation of liver: Primary graft nonfunction and hepatitis C virus are associated with worse outcome

Yoo

Maheshwari

Thuluvath

2003

Liver Transplantation

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It is not known whether the outcome of liver retransplantation (re-LT) is dependent on the indication for re-LT or cause of liver disease. In this study, our aim is to compare the outcome of re-LT in adults with that of primary liver transplantation (PLT) and determine whether the outcome of re-LT is dependent on its indication. United Network for Organ Sharing data from 1988 to 2001 were used for the study. Of 34,267 patients who met our inclusion criteria, 761 patients underwent re-LT for primary graft nonfunction (PGNF; group 1), 3,428 patients underwent re-LT for other reasons (group 2), and 30,078 patients underwent PLT (group 3). There was a greater incidence of PGNF (9.4% v 4.0%; P < .001) and regrafting (23.1% v 7.4%; P < .001) in the re-LT groups compared with the PLT group. Kaplan-Meier analysis and Cox regression analysis, after adjusting for confounding risk factors, showed significantly lower short-and longterm patient and graft survival in the re-LT groups compared with the PLT group. Kaplan-Meier survival showed lower patient and graft survival in group 1 compared with group 2. However, only graft, not patient, survival was lower in group 1 by Cox regression analysis when adjusted for other risk factors. Patients with hepatitis C virus (HCV) infection who underwent re-LT had lower patient and graft survival compared with those without HCV infection, and HCV was an independent predictor of mortality after re-LT. Re-LT was associated with a greater rate of complications and lower patient and graft survival compared with PLT. Re-LT for PGNF and HCV infection was associated with lower patient and graft survival compared with re-LT for other causes. (Liver Transpl 2003;9: 897-904.)

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Retransplantation of liver: Primary graft nonfunction and hepatitis C virus are associated with worse outcome

Yoo

Maheshwari

Thuluvath

2003

Liver Transplantation

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“…107 Patients with diabetes or coronary artery disease, both commonly associated with obesity, are approximately 40% more likely to die within 5 years of liver transplantation compared to non-diabetics or to patients without coronary artery disease. 108,109 Metabolic syndrome, a disorder in which obesity, insulin resistance, high blood pressure and dyslipidemia coexist, is highly prevalent in liver transplant patients 110 and is predicted by alcoholic etiology of cirrhosis, excessive weight prior to transplantation, as well as reduced intakes of calcium, potassium, fiber and folate. 110 Finally, in line with these observations, despite excellent graft function, many long-term liver transplant survivors manifest a sarcopenic obesity-phenotype characterized by increased body fat but low muscle mass.…”

Section: Malnutrition and Outcome Following Liver Transplantationmentioning

confidence: 99%

Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

Bémeur

Butterworth

2015

Journal of Clinical and Experimental Hepatology

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“…The immediate and late outcome of liver transplantation is dependent on many factors including age, race, BMI, presence of diabetes or coronary artery disease (CAD), pretransplantation serum creatinine, etiology, severity of liver disease (Model for End-Stage Liver Disease score or United Network for Organ Sharing status), donor age, donor steatosis, and cold ischemia time. [21][22][23][24][25][26][27][28][29] Patients with diabetes or CAD are approximately 40% more likely to die within 5 yr from transplantation compared to nondiabetics or those without CAD. 28 The presence of both diseases has a far more negative impact than either disease alone.…”

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confidence: 99%

“…[21][22][23][24][25][26][27][28][29] Patients with diabetes or CAD are approximately 40% more likely to die within 5 yr from transplantation compared to nondiabetics or those without CAD. 28 The presence of both diseases has a far more negative impact than either disease alone. 28 Patients with morbid obesity often have more than 1 negative risk factor.…”

Section: See Article On Page 1678mentioning

confidence: 99%

“…28 The presence of both diseases has a far more negative impact than either disease alone. 28 Patients with morbid obesity often have more than 1 negative risk factor. A significant proportion of these patients is old and has occult cardiovascular disease, hyperlipidemia, diabetes mellitus, hypertension, renal impairment, or restrictive lung disease.…”

Section: See Article On Page 1678mentioning

confidence: 99%

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Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

Thuluvath

2007

Liver Transpl

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The prevalence of obesity is increasing in the United States and the rest of the world. The World Health Organization reported last year that over a billion people in the world are obese, surpassing 600 million malnourished people. In some ways, this is a reassuring sign that we are combating poverty in the world, but the impact of obesity on long-term morbidity, mortality, and utilization of health resources is similar or higher. [1][2][3][4][5] The reports from the Centers for Disease Control and the National Health and Nutrition Examination Surveys suggest that Ͼ20% of the U.S. population is obese as defined by a body mass index (BMI) Ͼ30 kg/ m 2 . Whereas infections are the most common causes of death in the malnourished, degenerative and vascular diseases are the common causes of death in obese people. [1][2][3][4][5] The Centers for Disease Control estimates that approximately 100 billion dollars are spent every year in the United States on obesity-related type 2 diabetes mellitus and 22 billion on obesity-related osteoarthritis.The United Network for Organ Sharing database from 1988 to 1996 showed that 16.8% of liver transplant recipients had BMI Ն30 kg/m 2 and of these 5.3% were severely obese (BMI Ն35 kg/m 2 ) and 2.1% were morbidly obese (BMI Ն40 kg/m 2 ). 6 The study reported in this issue of Liver Transplantation by Pelletier et al. 7 shows that the prevalence of obesity has increased significantly in more recent years. Of those who underwent transplantation between 2001 and 2004, 32.5% were obese, and among them, 8.4% were severely obese and 3.2% were morbidly obese. Within a decade, it appears that the prevalence of obesity (BMI Ն30 kg/m 2 ) has increased by 93% among liver transplant recipients, and moreover, there was 58% increase in severe obesity and 52% increase in morbid obesity. This increase is mostly a reflection of the changes in the general population. Fluid overload and inactivity, probably related to the advanced liver disease, may have contributed to the increased prevalence of obesity in this population, but it is difficult to assume that these factors have changed in the past decade. 4 Nevertheless, these data indicate that we need to continue to monitor the outcomes of obese patients on a continuous basis as the epidemiology is rapidly shifting in the wrong direction.The impact of obesity on renal transplantation has been studied more extensively than liver transplantation. 8,9 An analysis of 51,927 renal transplant recipients showed that extremes of BMI (Ͻ18 and Ͼ36) were associated with worse graft and patient survival. 8 In addition, higher BMI was associated with delayed graft function and chronic graft failure. Registry data (from 1987 to 2002) on 6,658 children aged 2 to 17 yr who received renal transplantation showed that BMI Ͼ95 percentile (9.7% of the study population) for age was associated with a higher risk of death (relative risk 2.9 for cadaver and 3.7 for living donor) and graft loss (19% vs. 10% for nonobese) due to thrombosis. 10 Obesity has also been described a...

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The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation

Abstract: Type 1 and CAD are both independent predictors of poor outcome after liver transplantation. Liver transplant recipients with type 1 or CAD have approximately 40% lower 5-year survival compared with patients without DM or CAD.

Cited by 111 publications

References 10 publications

Retransplantation of liver: Primary graft nonfunction and hepatitis C virus are associated with worse outcome

Retransplantation of liver: Primary graft nonfunction and hepatitis C virus are associated with worse outcome

Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications

Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

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