Incidence of new-onset diabetes and posttransplant metabolic syndrome after liver transplantation - A prospective Study From South India

Abstract

Background and Aims: Liver transplantation has become an effective therapy for patients with end-stage liver disease. The risk of new-onset diabetes after transplantation (NODAT) and posttransplant metabolic syndrome (PTMS) is high among patients after liver transplantation. These are thought to be associated with increased risks of graft rejection, infection, cardiovascular disease, and death. Our study aimed to document the incidence of NODAT and PTMS and analyze pre and posttransplant predictive factors for their development in patients undergoing a liver transplant. Methods: This was a prospective comparative study on 51 patients who underwent live donor liver transplantation. They were evaluated at baseline, 3 and 6 months after transplantation with fasting glucose, lipids, serum insulin levels, C-peptide, and HbA1C. They were followed up at 5 years to document any cardiovascular events or rejection. Results: The incidence of preoperative diabetes mellitus (DM) in the study group was 25/51 (49%). The incidence of NODAT was 38.5% (10/26 patients) and PTMS 29% (10/35), respectively. Age (47.7 ± 5.4 vs 41.5 ± 12.7 years), HOMA2 - IR (2.3 ± 1.8 vs 2.1 ± 1.6), serum insulin (16.1 ± 12.0 vs 17.9 ± 14.5), and C-peptide (4.6 ± 0.5 vs 4.8 ± 0.7) were similar at baseline in the NODAT group compared to those who did not develop it. Mean tacrolimus levels were higher in PTMS group (6.8 ± 2.9 vs 5.0. ± 2.0 P value = 0.042). By the end of 5 years, 7 patients expired; 6 due to rejection and one due to cardiovascular disease. Moreover, 2 of these patients had preexisting DM and 2 had NODAT. Conclusions: None of the baseline metabolic factors in patients undergoing liver transplant were predictive of the development of NODAT or PTMS. Mean tacrolimus levels were significantly higher in the PTMS group. A 5-year follow-up showed no excess risk of cardiovascular events or rejection in those with preexisting DM or in those who developed NODAT.

A Time-Based Meta-Analysis on the Incidence of New Onset Diabetes after Liver Transplantation

“…Figure 1 shows the flowchart of the inclusion process. The articles originated from various countries, with six articles originating from each USA [ 31 , 32 , 33 , 34 , 35 , 36 ] and China [ 6 , 15 , 37 , 38 , 39 ] respectively, three from France [ 40 , 41 , 42 ], two each from India [ 43 , 44 ], Japan [ 45 , 46 ], Spain [ 47 , 48 ], one each from Canada [ 49 ], Egypt [ 50 ], Germany [ 51 ], Iran [ 52 ], Korea [ 53 ], Taiwan [ 54 ], UK [ 55 ]. Studies were conducted from 1989 till 2018.…”

New-Onset Diabetes in COVID-19: Time to Frame Its Fearful Symmetry

“…Similarly, a correlation of plasma glucose on admission with radiographic evidence of acute respiratory distress syndrome (ARDS) irrespective of prior DM or no DM has been documented [ 14 ]. Perhaps, the latter is hardly surprising, given the established observation that new-onset hyperglycaemia may result from various clinical conditions, notably HIV and other viral infections [ 15 , 16 ], organ transplantation [ 17 ], stroke [ 18 ] and myocardial infarction [ 19 ]. Of note, in such conditions new hyperglycaemia portends a very sinister prognosis.…”

De novo metabolic syndrome after liver transplantation: a meta-analysis on cumulative incidence, risk factors, and outcomes

“…Of the 15 included cohort studies, majority were retrospective (n = 14) and there was one prospective study. The studies were conducted in various countries including 4 in Italy, [30][31][32][33] 3 in Spain, [34][35][36] and one in the United States, [37] Australia, [38] Belgium, [39] Singapore, [40] China, [41] Israel, [42] Germany, [5] and India, [43] respectively. A total of 2683 LT recipients were included in this study, with 740 patients developing de novo PTMS.…”