The effect of insulin-dependent diabetes mellitus on outcome of liver transplantation.
BACKGROUND
It is not known whether there was a difference in outcome between insulin-dependent diabetes mellitus (type 1) and non-insulin dependent diabetes mellitus (type 2) after liver transplantation.


METHODS
The outcome of liver transplantation in adult patients with type 1 (n=1,629) and type 2 (n=1,618) was compared to those without diabetes mellitus (DM) (nondiabetics, n=17,974) using the United Network for Organ Sharing database from 1994 to 2001, after excluding patients who had living donor or multiple organs or who underwent retransplantation, and those with incomplete data.


RESULTS
Cryptogenic cirrhosis, hypertension, and coronary artery disease (CAD) were two to three times more common in types 1 and 2 compared with nondiabetics. Five-year patient and graft survivals by Kaplan-Meier analysis were significantly lower for type 1 (P <0.0001) compared with type 2 or nondiabetics; only patient survival was lower for type 2 ( P=0.04). Cox regression survival analysis, after adjusting for confounding variables, showed a lower 1-year, 2-year, and 5-year patient and graft survival in patients with type 1 compared with nondiabetics; however, type 2 was not an independent predictor of survival. Preexisting CAD, and not hypertension, was also an independent predictor of poor 5-year survival. Patients who had both DM and CAD had a lower survival compared with those with either DM or CAD.


CONCLUSIONS
Type 1 and CAD are both independent predictors of poor outcome after liver transplantation. Liver transplant recipients with type 1 or CAD have approximately 40% lower 5-year survival compared with patients without DM or CAD.
Yoo
Hwan Y
HY
Department of Medicine, Johns Hopkins University Hospital, Baltimore, MD 21205, USA. pjthuluv@jhmi.edu
Thuluvath
Paul J
PJ
D000328:Adult; D003327:Coronary Disease / Q000150:complications; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome