Influence of Type 2 Diabetes Mellitus and Preoperative Hemoglobin A1c Levels on Outcomes of Liver Transplantation

Abstract

Liver transplant centers often establish hemoglobin A1c (HbA1C) criteria for candidates with type 2 diabetes mellitus (T2DM) based on data from other surgical specialties showing worse outcomes in patients with poor glycemic control. However, because of the reduced reliability of HbA1C in cirrhosis, it is unclear whether pretransplant HbA1C values are predictive of postoperative complications in liver recipients. We retrospectively examined the association between preoperative HbA1C and postoperative outcomes in 173 consecutive patients who underwent liver transplantation at the University of Cincinnati Medical Center between August 2012 and March 2015. Demographic correlates of pretransplant HbA1C included age, T2DM, native Model for End‐Stage Liver Disease, hemoglobin, serum albumin, and nonalcoholic steatohepatitis as the indication for transplantation. No association was identified between pretransplant HbA1C and most outcome measures, including survival, length of stay, reoperation or readmission rates, rejection, bacteremia, and viremia. Significant correlates of HbA1C in liver recipients with diabetes were posttransplant insulin requirement and anastomotic biliary stricture formation. On multivariate analysis, HbA1C was the sole determinant of biliary strictures, with patients in the highest quartile (HbA1C >7.3%) exhibiting a 4‐fold increased risk. Correlation of HbA1C with morning blood glucose levels was much tighter after versus before transplantation. Conclusion: Preoperative HbA1C is predictive of anastomotic biliary stricture formation and the need for insulin following liver transplantation.

A Translational In Vivo and In Vitro Metabolomic Study Reveals Altered Metabolic Pathways in Red Blood Cells of Type 2 Diabetes

“…This makes the exploration of new biomarkers an attractive field to improve the management of diabetes. In this regard, new diagnostic approaches for precision medicine could complement or even improve the current parameters used in the clinic such as glycosylated haemoglobin (HbA1c) or blood glucose levels [ 15 , 16 , 17 ]. For instance, additional biomarkers could help to select a more appropriate treatment, or provide a better classification in terms of risk of comorbidities.…”

Glycated haemoglobin and the risk of postoperative complications in people without diabetes: a prospective population‐based study in UK Biobank

“…For example, of the seven observational studies in orthopaedic surgery published in the last decade that examined hyperglycaemia and postoperative outcome in people with and without diabetes, all analysed those with and without the condition together. These types of analyses are also present in all studies in head and neck [15], thoracic [16], hepatobiliary [17–19] and neurosurgery [20, 21] and in the majority of papers in cardiac [22–31], lower [32–34] and upper [34, 35] gastro‐intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

“…hepatobiliary [17][18][19] and neurosurgery [20,21] and in the majority of papers in cardiac [22][23][24][25][26][27][28][29][30][31], lower [32][33][34] and upper [34,35] gastro-intestinal surgery. People with diabetes have increased risk of cardiovascular, renal, ophthalmic and neurological morbidities.…”

Prevalence and risk factors of undiagnosed diabetes mellitus among gastroenterological patients: a HbA1c-based single center experience – Prevalence of undiagnosed diabetes in gastroenterological patients

“…Although each of the parameters used for diabetes screening, HbA 1c and FDG, is sufficient to establish the diagnosis of diabetes on its own, we decided to determine both in eligible patients, since both parameters have limitations in their diagnostic accuracy [25]. To minimize additional workload in praxis, a preselection of patients based on previously described risk-calculators (FIN-DRISK [26], etc.)…”