Prevalence, predictive factors, and survival outcome of new-onset diabetes after liver transplantation

Liu, Fu-Chao; Lin, Jainn-Jim; Chen, Hsiu-Pin; Tsai, Yung-Fong; Yu, Huang-Ping

doi:10.1097/md.0000000000003829

Cited by 21 publications

(29 citation statements)

References 40 publications

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“…It is probably fair to estimate that the accumulated incidence of PTDM is about 30-40% in liver transplant recipients although somewhat lower incidence rates may occur in Asian cohorts (111)(112)(113), Table 1.…”

Section: Liver Transplantationmentioning

confidence: 99%

“…Registry data indicate that PTDM significantly increases mortality risk in liver transplanted patients. A study from Taiwan used the National Insurance Research Database reported on more than 2000 patients who were liver transplanted between 1998 and 2013 (113). Patients with PTDM had a 5-yr cumulative mortality similar to patients with pretransplant diabetes and higher than those without diabetes.…”

Section: Liver Transplantationmentioning

confidence: 99%

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Post-transplant diabetes mellitus in patients with solid organ transplants

2019

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Solid organ transplantation (SOT) is an established treatment for patients with end-organ disease. SOT is also a life-saving procedure although kidney failure patients may survive with dialysis treatment. However, transplantation is accompanied by associated cardiovascular risk factors, and post-transplant diabetes mellitus (PTDM) is one of the most important ones. PTDM develops in 10-20% of kidney transplanted patients and in some 20-40% of other SOT patients. PTDM patients have twice as high mortality as other SOT patients at least in kidney and heart transplanted patients. PTDM is elicited both by predisposing factors as in type2 diabetes but also by specific post-transplant risk factors. Even though PTDM has many characteristics in common with type 2 diabetes, prevention and treatment is often different. SOT patients have improved their lifespan over the last twenty years, and PTDM accumulates over time in these patients. Accordingly PTDM becomes and important condition not only to be aware of, but also to handle. The aim of this review is to present current knowledge on PTDM in kidney, heart, liver and lung transplant recipients, not only for transplant health providers, but also for endocrinologists and others who will meet these patients in their clinic.

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Section: Liver Transplantationmentioning

confidence: 99%

Section: Liver Transplantationmentioning

confidence: 99%

Post-transplant diabetes mellitus in patients with solid organ transplants

2019

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“…These data are relevant because some patients develop diabetes after liver transplantation. The preoperative risks for developing this condition include advanced age, alcoholic hepatitis, ascites, hepatic coma, and esophageal varices (Liu et al, ).…”

Section: Metabolic Disordersmentioning

confidence: 99%

Effects of Silymarin on Diabetes Mellitus Complications: A Review

2017

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Diabetes mellitus is a common metabolic disorder that is caused by a deficit in the production of (type 1) or response to (type 2) insulin. Diabetes mellitus is characterized by a state of chronic hyperglycemia and such symptoms as weight loss, thirst, polyuria, and blurred vision. These disturbances represent one of the major causes of morbidity and mortality nowadays, despite available treatments, such as insulin, insulin secretagogues, insulin sensitizers, and oral hypoglycemic agents. However, many efforts have been made to discover new drugs for diabetes treatment, including medicinal plant extracts. Silymarin is a powder extract of the seeds from Silybum marianum, a plant from the Asteraceae family. The major active ingredients include four isomers: silybin, isosilybin, silychristin, and silydianin. Silymarin is indicated for the treatment of hepatic disorders, such as cirrhosis, chronic hepatitis, and gallstones. Moreover, several studies of other pathologies, including diabetes, sepsis, osteoporosis, arthritis, hypercholesterolemia, cancer, viral infections, and Alzheimer's and Parkinson's diseases, have tested the effects of silymarin and reported promising results. This article reviews data from clinical, in vivo, and in vitro studies on the use of silymarin, with a focus on the complications of diabetes, including nephropathy, neuropathy, healing delays, oxidative stress, hepatotoxicity, and cardiomyopathy. Copyright © 2017 John Wiley & Sons, Ltd.

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“… 1 The incidence of NODAT is higher during the early post-transplant period because of the exposure to high doses of corticosteroids, calcineurin inhibitors (CNIs), and long-term physical inactivity. 3 , 4 A meta-analysis including 20 studies concluded that hepatitis C virus infection, impaired fasting glucose, family history of diabetes, male sex, old age, use of tacrolimus (TAC), and obesity are significant risk factors for NODAT. 2 The pathogenesis of NODAT is generally explained by CNIs inducing pancreatic beta-cell dysfunction and the gluconeogenesis effect of steroids resulting in insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients

Liu

Lin

et al. 2017

TCRM

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This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140 patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications before prescribing immunosuppressants for liver transplant recipients.

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Prevalence, predictive factors, and survival outcome of new-onset diabetes after liver transplantation

Abstract: Supplemental Digital Content is available in the text

Cited by 21 publications

References 40 publications

Post-transplant diabetes mellitus in patients with solid organ transplants

Post-transplant diabetes mellitus in patients with solid organ transplants

Effects of Silymarin on Diabetes Mellitus Complications: A Review

Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients

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