Diabetes mellitus after liver transplant new etiologic clues and cornerstones for understanding.
A retrospective study was performed on all orthotopic liver transplant (OLT) recipients (n = 167) from a major French transplant center from January 1998 to December 2000. The investigation sought to determine the prevalence, predictive factors, and outcome of post-liver transplant diabetes mellitus (PTDM). PTDM was defined at 6 months post-OLT as hyperglycemia requiring treatment with insulin or oral hypoglycemic agents. The incidence was assessed for patient features, cause of liver disease, and immunosuppressive regimen. PTDM occurred in 45 of 143 OLT (31%), including 27 patients with pre-OLT persistent DM, whereas 26 developed de novo PTDM. Eight patients were cured of their post-OLT DM. PTDM treatment consisted of mainly insulin (n = 43). Patients given tacrolimus (n = 40) had a greater incidence of PTDM. Pre-OLT DM (n = 27), alcoholic cirrhosis (n = 30), and male gender (n = 38) were independent predictors of PTDM. Recipient HLA, steroid dosage, hepatitis C virus (HCV), and cholestatic liver disease were not predictive of PTDM. The incidences of graft loss as well as other morbidities and death rates were similar between the two groups. In conclusion, PTDM, common occurrence associated with male gender, alcoholic cirrhosis, and pre-OLT DM, seems at midterm follow-up to have no pejorative evolution when compared to patients without this complication.
Tueche
S G
SG
Department of General Surgery and Liver Transplantation, Hôpital Pontchaillou, Rennes, France. serge.tueche@wanadoo.fr
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000601:surgery; D008107:Liver Diseases / Q000145:classification / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome