Hepatitis C-related cirrhosis: a predictor of diabetes after liver transplantation.
Hepatitis C virus (HCV) infection has recently been suggested to be a risk factor for the development of diabetes mellitus. The aim of our study was to investigate whether the prevalence of diabetes is increased among liver transplant recipients infected with HCV. We compared the prevalence of diabetes among 278 liver transplant recipients whose original cause of liver failure was HCV infection (110 patients), hepatitis B virus infection (HBV; 53 patients), and cholestatic liver disease (CLD; 115 patients). The pretransplantation prevalence of diabetes was higher in the HCV group (29%) compared with the HBV (6%) and CLD (4%) groups (P <.001). The prevalence of diabetes remained higher in the HCV group 1 year after transplantation: 37%, 10%, and 5% in the HCV, HBV, and CLD groups, respectively (P <.001). The cumulative steroid dose during the first year of transplantation was significantly lower in the HCV group compared with the CLD group. Multivariate analysis revealed that HCV-related liver failure (P =.002), pretransplantation diabetes (P <.0001), and male sex (P =.019) were independent predictors of the presence of diabetes 1 year after transplantation. The high prevalence of diabetes persisted in the HCV group, with 41% diabetic at 5 years. The majority of patients with diabetes mellitus (89%) required insulin therapy after transplantation. Patient and graft survival rates were similar among patients with and without diabetes. In conclusion, our study shows that there is a high prevalence of diabetes among liver transplant recipients infected with HCV both before and after transplantation.
Bigam
D L
DL
Multiorgan Transplant Program, Toronto General Hospital, University Health Network, Toronto, Canada.
Pennington
J J
JJ
Carpentier
A
A
Wanless
I R
IR
Hemming
A W
AW
Croxford
R
R
Greig
P D
PD
Lilly
L B
LB
Heathcote
J E
JE
Levy
G A
GA
Cattral
M S
MS
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D017093:Liver Failure / Q000150:complications*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors