Negative impact of new-onset diabetes mellitus on patient and graft survival after liver transplantation: Long-term follow up.
BACKGROUND
Little is known about the long-term consequences of new-onset diabetes mellitus (NODM) after liver transplantation (LTX).


METHODS
In a chart review between 1996 and 2004, we evaluated its incidence and possible effect on patient and graft survival. Inclusion criteria were: adult primary LTX; deceased donor LTX without combined organs; and dual immunosuppression with tacrolimus and corticosteroid. Patients who died within six months after LTX were excluded. For analytical purposes, each patient was classified into one of four groups: 1) preLTX diabetes mellitus (DM): established DM before LTX; 2) sustained NODM: NODM sustained > or =6 months; 3) transitory NODM: NODM temporarily existed > or =1 and <6 months; and 4) normal: no DM either pre- or postLTX. Patients who had NODM <1 month due to high-dose steroid (e.g., either immediate postLTX or rejection treatment) were considered as normal. Patient and graft survival was examined using Kaplan-Meier methodology.


RESULTS
In all, 778 patients met the inclusion/exclusion criteria: preLTX DM 159 (20.4%), sustained NODM 284 (36.5%), transitory NODM 108 (13.9%), and normal 227 (29.2%). Median follow-up was 57.2 months. There was a significant difference in patient (P = 0.012) and graft survival (P = 0.004) among the groups, with sustained NODM showing the poorest patient and graft survivals. Sustained NODM patients had a significantly higher rate of death due to infection, as well as graft failure due to chronic rejection and late onset hepatic artery thrombosis.


CONCLUSIONS
NODM is a frequent complication with poor patient and graft survival after LTX.
Moon
Jang I
JI
Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA. jmoon@med.miami.edu
Barbeito
Ralph
R
Faradji
Raquel N
RN
Gaynor
Jeffrey J
JJ
Tzakis
Andreas G
AG
D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality*; D008297:Male; D008875:Middle Aged