Predictive factors for posttransplant diabetes mellitus within one-year of liver transplantation.
BACKGROUND
The aims of our single-center study were to identify whether pretransplant diabetes had an impact on patient survival and, secondly, the predictive factors for development of new-onset diabetes mellitus (NODM) (as defined by American Diabetes Association/World Health Organization).


METHODS
One hundred seventy-nine consecutive adult orthotopic liver-transplant patients were included in this study. Immunosuppression was based on calcineurin inhibitors with steroids, with or without mycophenolate mofetil, and with or without induction therapy. To evaluate the predictive factors for NODM, donor and recipient pre- and posttransplant data were included.


RESULTS
At transplantation, 38 patients had diabetes (group I), and the 141 nondiabetic patients constituted group II. In group I, paternal history of diabetes was more frequent (P=0.03), as was length of exposure to smoking (P=0.03), higher pretransplant glycemia (P<0.001), and shorter cold-ischemia (P=0.027) compared with group II. Pretransplant diabetes in group I resulted in a mortality rate of 39.5% at 1 year compared with 19.1% in group II (P=0.009). In group II, in multivariate analysis, independent predictive factors for NODM at M12 were pretransplant glycemia (P=0.037), alcohol-induced end-stage liver disease (P=0.04), and cumulative steroid dose within 1-year posttransplant (P=0.05).


CONCLUSIONS
Of the independent predictive risk factors for NODM, only steroid dose is modifiable, emphasizing the need for individualized immunosuppression.
Oufroukhi
Loubna
L
Department of Nephrology, Dialysis and Multiorgan Transplant Unit, CHU Rangueil, Toulouse Cédex 9, France.
Kamar
Nassim
N
Muscari
Fabrice
F
Lavayssière
Laurence
L
Guitard
Joëlle
J
Ribes
Davis
D
Esposito
Laure
L
Alric
Laurent
L
Hanaire
Hélène
H
Rostaing
Lionel
L
D000328:Adult; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors