The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US

Abstract

Summary Background Type 2 diabetes is known to negatively impact the outcome of chronic liver disease. Aim To evaluate the impact of diabetes on the outcomes of liver transplants (LT). Methods Study cohort included adults (>18 years) who received LT in the US between 1994 and 2013 (The Scientific Registry of Transplant Recipients). Pre‐ and post‐transplant diabetes was recorded in patients with mortality follow‐up. Results We included 85 194 liver transplant recipients. Of those, 11.2% had history of pre‐transplant diabetes. The most common indications for liver transplant were hepatitis C (36.4%), alcohol‐related liver disease (20.6%), primary liver malignancy of unspecified aetiology (14.7%), cryptogenic cirrhosis (8.0%), hepatitis B (4.6%) and non‐alcoholic steatohepatitis (3.9%). A total of 96.5% transplants were from deceased donors, and 7.9% donors had history of diabetes. During an average 6.5 years of follow‐up, 31.3% recipients died and 8.8% had a graft failure. In multivariate survival analysis [at least 5 years of cohort follow‐up (N = 35 870)], after adjustment for age, ethnicity, insurance type, history of chronic diseases, HCV infection and noncompliance, independent predictors of recipient mortality included the presence of pre‐transplant diabetes [adjusted hazard ratio (95%CI) = 1.21 (1.12–1.30)] and developing diabetes post‐transplant [1.06 (1.02–1.11)]. Donor's history of diabetes was also independently associated with higher mortality [1.10 (1.02–1.19)]. Furthermore, donor's history of diabetes was also associated with an increased the risk of liver graft failure [1.35 (1.24–1.47)]. Conclusions Presence of type 2 diabetes pre‐ and post‐transplant, as well as presence of type 2 diabetes in the donors, are all associated with an increased risk of adverse post‐transplant outcomes.

Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

“…To our knowledge, this is the first nationwide population-based study to investigate the effects of DM on the risk of post-LTx mortality and morbidity in an Asian population. Contrary to the previous publications [13][14][15][16], we observed that DM patients did not exhibit increased risks of early post-LTx morbidities or mortality compared with non-DM patients. However, further analysis showed that preexisting DM with renal manifestations was associated with a significantly higher mortality rate within 90 days after LTx, in comparison with the non-DM cohort.…”

“…To date, some studies have evaluated the risk of perioperative mortality and complications after LTx in DM patients in a population-based setting [13][14][15][16]. However, there has been no similar study in an Asian population.…”

Additive impact of pre‐liver transplant metabolic factors on survival post‐liver transplant

“…Many investigators have examined the association between pre‐transplant diabetes and obesity on post‐transplant outcomes . These studies have examined the independent effects of obesity and diabetes; however, given the frequency with which they co‐exist, it is surprising that there is a lack of knowledge regarding the additive effects of concomitant metabolic factors on outcomes.…”

“…No significant difference in cardiovascular mortality was found among patients with diabetes and obesity compared with those without. This may be due to lack of power to determine an association, noting that larger studies have found diabetes to be a risk factor for cardiovascular death . Significantly, the proportion of deaths due to cardiovascular disease in our entire cohort was only 3.6%, which is lower than reported in the SRTR (10% at 5 years) .…”

“…Pre‐transplant diabetes has been reported from single center studies as being associated with either reduced post‐OLT survival or having no impact on survival . However, the most recent analysis of the Scientific Registry of Transplant Recipients (SRTR) database demonstrated that a history of type 2 diabetes was associated with a 20% increase in mortality risk post‐transplant . Studies utilizing the SRTR database have demonstrated reduced survival among diabetics only if they were insulin requiring or had underlying chronic hepatitis C infection .…”