Risk Factors for New-Onset Diabetes Mellitus in Adult Liver Transplant Recipients, an Analysis of the Organ Procurement and Transplant Network/United Network for Organ Sharing Database

Abstract

OBJECTIVE.: To analyze the risk factors for new-onset diabetes mellitus (NODM) in liver transplant recipients using the Organ Procurement and Transplant Network/United Network for Organ Sharing database. METHODS.: Among 20,172 primary liver recipients (age > or =18 years) transplanted between July 2004 and December 2008 in Organ Procurement and Transplant Network/United Network for Organ Sharing databases, 15,463 recipients without pretransplant diabetes were identified. Risk factors for NODM were examined using multivariate Cox regression analysis. RESULTS.: NODM was reported in 26.4% of recipients (median follow-up, 685 days). Independent predictors of NODM development included recipient age (> or = 50 vs. <50 years, hazard ratio [HR]=1.241), African American race (HR=1.147), body mass index (> or = 25 vs. <25, HR=1.186), hepatitis C (HR=1.155), recipient cirrhosis history (HR=1.107), donor age (> or = 60 vs. <60 year, HR=1.152), diabetic donor (HR=1.151), tacrolimus (tacrolimus vs. cyclosporine, HR=1.236), and steroid at discharge (HR=1.594). Living donor transplant (HR=0.628) and induction therapy (HR=0.816) were associated with a decreased risk of NODM. CONCLUSION.: The incidence of NODM was 26.4% in liver recipients with a median follow-up time of 685 days. Identified risk factors for NODM in liver transplantation were similar to that in kidney transplantation. Some of the identified factors are potentially modifiable, including obesity and the choice of immunosuppressive regimens.

Adult liver transplantation in the USA

“…Independent predictors of NODM include recipient age over 50 years, African American race, BMI higher than 25 kg/m 2 , presence of HCV infection, donor age more than 60 years, a diabetic donor, and the use of tacrolimus and corticosteroids at discharge. Living donor transplant and use of induction immunosuppressive therapy were associated with a decreased risk of NODM [66 ]. Obesity develops in up to 50% of patients after transplant, the majority of weight gain occurring within the first 6 months [67 ].…”

Recurrence of non-viral liver disease after orthotopic liver transplantation

“…Further research is needed to evaluate the relationship between the use of immunosuppressant agents and the recurrence of NASH after liver transplant. Calcinuerin inhibitors are known to be diabetogenic and are also known to have many increased metabolic risk factors post-transplant (70). In addition, the cumulative corticosteroid dose after LT has been shown to predict the recurrence of NASH in the allograft (63).…”

Guidelines for liver transplantation for patients with non-alcoholic steatohepatitis

“…Ciclosporin and tacrolimus have slightly differing effects on some of these risks: for example, new onset diabetes after transplantation is more common with tacrolimus than ciclosporin110 while hyperlipidaemia is more common with ciclosporin 109. Due to superior patient outcome, tacrolimus is preferred to ciclosporin and is the firstline CNI used in clinical practice 117…”