Aloysious D Aravinthan1,2,3, Waleed Fateen2,3, Adam C Doyle1,4, Suresh V Venkatachalapathy3, Assaf Issachar1,5, Zita Galvin1, Gonzalo Sapisochin1, Mark S Cattral1, Anand Ghanekar1, Ian D McGilvray1, Markus Selzner1, David R Grant1, Nazia Selzner1, Leslie B Lilly1, Eberhard L Renner1,6, Mamatha Bhat1. 1. Multiorgan Transplant Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 2. Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom. 3. National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, United Kingdom. 4. Department of Gastroenterology and Hepatology, Royal Perth Hospital, Perth, Australia. 5. Liver Institute, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. 6. Department of Medicine, Max Rady College of Medicine/Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Abstract
BACKGROUND: Diabetes mellitus (DM) is said to adversely affect transplant outcomes. The aim of this study was to investigate the impact of pre-existing and new-onset DM on liver transplantation (LT) recipients. METHODS: A single-center retrospective analysis of prospectively collected data of LT recipients (1990-2015) was undertaken. RESULTS: Of the 2209 patients, 13% (n = 298) had Pre-DM, 16% (n = 362) developed post-transplant diabetes mellitus (PTDM), 5% (n = 118) developed transient hyperglycemia (t-HG) post-LT, and 65% (n = 1431) never developed DM (no DM). Baseline clinical characteristics of patients with PTDM were similar to that of patients with Pre-DM. Incidence of PTDM peaked during the first year (87%) and plateaued thereafter. On multivariate analysis (Bonferroni-corrected), nonalcoholic fatty liver disease and the use of tacrolimus and sirolimus were independently associated with PTDM development. Both Pre-DM and PTDM patients had satisfactory and comparable glycemic control throughout the follow-up period. Those who developed t-HG seem to have a unique characteristic compared with others. Overall, 9%, 5%, and 8% of patients developed end-stage renal disease (ESRD), major cardiovascular event (mCVE), and de novo cancer, respectively. Both Pre-DM and PTDM did not adversely affect patient survival, retransplantation, or de novo cancer. The risks of ESRD and mCVE were significantly higher in patients with Pre-DM followed by PTDM and no DM. CONCLUSIONS: In this largest nonregistry study, patients with Pre-DM and PTDM share similar baseline clinical characteristics. Pre-DM increases the risk of ESRD and mCVE; however, patient survival was comparable to those with PTDM and without diabetes. Understanding the impact of PTDM would need prolonged follow-up.
BACKGROUND:Diabetes mellitus (DM) is said to adversely affect transplant outcomes. The aim of this study was to investigate the impact of pre-existing and new-onset DM on liver transplantation (LT) recipients. METHODS: A single-center retrospective analysis of prospectively collected data of LT recipients (1990-2015) was undertaken. RESULTS: Of the 2209 patients, 13% (n = 298) had Pre-DM, 16% (n = 362) developed post-transplant diabetes mellitus (PTDM), 5% (n = 118) developed transient hyperglycemia (t-HG) post-LT, and 65% (n = 1431) never developed DM (no DM). Baseline clinical characteristics of patients with PTDM were similar to that of patients with Pre-DM. Incidence of PTDM peaked during the first year (87%) and plateaued thereafter. On multivariate analysis (Bonferroni-corrected), nonalcoholic fatty liver disease and the use of tacrolimus and sirolimus were independently associated with PTDM development. Both Pre-DM and PTDMpatients had satisfactory and comparable glycemic control throughout the follow-up period. Those who developed t-HG seem to have a unique characteristic compared with others. Overall, 9%, 5%, and 8% of patients developed end-stage renal disease (ESRD), major cardiovascular event (mCVE), and de novo cancer, respectively. Both Pre-DM and PTDM did not adversely affect patient survival, retransplantation, or de novo cancer. The risks of ESRD and mCVE were significantly higher in patients with Pre-DM followed by PTDM and no DM. CONCLUSIONS: In this largest nonregistry study, patients with Pre-DM and PTDM share similar baseline clinical characteristics. Pre-DM increases the risk of ESRD and mCVE; however, patient survival was comparable to those with PTDM and without diabetes. Understanding the impact of PTDM would need prolonged follow-up.
Authors: Cynthia Tsien; Huey Tan; Sowmya Sharma; Naaventhan Palaniyappan; Pramudi Wijayasiri; Kristel Leung; Jatinder Hayre; Elizabeth Mowlem; Rachel Kang; Peter J Eddowes; Emilie Wilkes; Suresh V Venkatachalapathy; Indra N Guha; Lilia Antonova; Angela C Cheung; William Jh Griffiths; Andrew J Butler; Stephen D Ryder; Martin W James; Guruprasad P Aithal; Aloysious D Aravinthan Journal: Clin Med (Lond) Date: 2021-01 Impact factor: 2.659
Authors: Yi Wu; Weiliang Jiang; Xiaojun Yang; Wenhua Li; Rong Wan; Lungen Lu; Junwei Fan; Zhanjun Lu Journal: Zhejiang Da Xue Xue Bao Yi Xue Ban Date: 2021-04-25
Authors: Yip Han Chin; Hon Qin Marcus Tan; Cheng Han Ng; Darren Jun Hao Tan; Snow Yunni Lin; Daniel Q Huang; Chin Meng Khoo; Mark Dhinesh Muthiah Journal: J Clin Med Date: 2021-03-03 Impact factor: 4.241