The impact of liver transplantation on diabetes mellitus

New onset diabetes mellitus after liver transplantation and hepatitis C virus infection: meta-analysis of clinical studies

New onset diabetes mellitus (NODM) postliver transplantation (LT) is very common and may negatively affect patient and graft survival, but its causative mechanism is still unclear. This study was to analyze the connection between Hepatitis C virus (HCV) infection and NODM after LT by systematically reviewing published medical literature. We electronically searched databases of MEDLINE, EMBASE and the Cochrane Library from January 1980 to January 2008. Only retrospective studies could be identified. Seven of them were subjected to the meta-analysis. Analysis was performed by using revman 4.2 software. We found that HCV increased the prevalence of NODM [OR 2.46; 95%CI (1.44, 4.19)]. Then, we further analyzed the association between HCV and persistent-NODM (P-NODM) after LT. The result showed that prevalence of P-NODM was higher in HCV-positive group than in HCV-negative group with marginally statistical significance [OR = 1.39; 95%CI (1.06, 1.83)]. The present meta-analysis based on retrospective studies suggested a significant relationship between HCV and NODM after LT, and it seems that HCV infection might also increase the prevalence of P-NODM. Multicenter, large sized prospective studies are still needed to further confirm these results.

Prevalence and risk factors for diabetes mellitus in moderate term survivors of liver transplantation

The prevalence and risk factors for diabetes mellitus after liver transplantation are not well understood. Thus, we sought to identify independent risk factors for the development of diabetes after liver transplantation using currently accepted medical criteria. We studied the prevalence and risk factors in 253 adult recipients transplanted at UCLA between January 1998 and December 2002. Analysis of the retrospective data was performed using demographic, immunosuppression and liver disease variables. Factors found to be significant on a univariate analysis were further studied in a multivariate analysis. There were 158 men and 95 women in our study. The mean age was 51.4 +/- 11.0 years. The mean [+/- standard deviation (SD) pretransplant body mass index was 26.7 (+/-5.1). Most patients were transplanted for hepatitis C (HCV). The prevalence of diabetes after transplantation was 17.8%. In a multivariate analysis only gender [odds ratio (OR) = 0.37; p = 0.02] was independently predictive of the development of diabetes. This study in a large liver transplant recipient population identifies male gender as an independent risk factor for the development of diabetes. Follow-up studies are needed to assess the impact of diabetes, and its intervention on post-transplant morbidity and mortality.

Diabetes mellitus after liver transplant new etiologic clues and cornerstones for understanding

A retrospective study was performed on all orthotopic liver transplant (OLT) recipients (n = 167) from a major French transplant center from January 1998 to December 2000. The investigation sought to determine the prevalence, predictive factors, and outcome of post-liver transplant diabetes mellitus (PTDM). PTDM was defined at 6 months post-OLT as hyperglycemia requiring treatment with insulin or oral hypoglycemic agents. The incidence was assessed for patient features, cause of liver disease, and immunosuppressive regimen. PTDM occurred in 45 of 143 OLT (31%), including 27 patients with pre-OLT persistent DM, whereas 26 developed de novo PTDM. Eight patients were cured of their post-OLT DM. PTDM treatment consisted of mainly insulin (n = 43). Patients given tacrolimus (n = 40) had a greater incidence of PTDM. Pre-OLT DM (n = 27), alcoholic cirrhosis (n = 30), and male gender (n = 38) were independent predictors of PTDM. Recipient HLA, steroid dosage, hepatitis C virus (HCV), and cholestatic liver disease were not predictive of PTDM. The incidences of graft loss as well as other morbidities and death rates were similar between the two groups. In conclusion, PTDM, common occurrence associated with male gender, alcoholic cirrhosis, and pre-OLT DM, seems at midterm follow-up to have no pejorative evolution when compared to patients without this complication.