title: Diabetes mellitus increases the risk of mortality following liver transplantation independent of MELD score.
abstract: BACKGROUND
  Patients with diabetes mellitus overall experience worse health outcomes than non-diabetics, but whether this is true among recipients of liver transplantation still remains unclear. The aim of this study was to compare the mortality of diabetic and non-diabetic patients following liver transplantation.
  
  
  METHODS
  We conducted a retrospective analysis of 530 adult patients undergoing liver transplantation at Stanford University Medical Center from February 1995 to July 2006. Information on diabetes mellitus was available for 431 patients; 96 patients who had acute liver failure (n = 17), combined liver and kidney transplantation (n = 28), or died prior to discharge (n = 51) were excluded from analysis.
  
  
  RESULTS
  Over a mean follow-up of 4.5 years, survival was 81% in the diabetic group and 94% among controls (p = <0.0001). After controlling for age (mean +/- SD: 54.4 +/- 7.6 in diabetics, 50.1 +/- 9.6 in controls), body mass index (28.6 +/- 6.6 in diabetics, 27.1 +/- 5.4 in controls), presence of hepatitis C, and MELD score (17 +/- 9.6 in diabetics, 19 +/- 10.2 in controls), diabetes mellitus remained a significant predictor of death (HR 3.11, p = 0.01).
  
  
  CONCLUSIONS
  Diabetes mellitus is an independent risk factor for mortality following liver transplantation. Further investigation of this relationship should focus on the impact of more intensive pre- and post-liver transplantation glucose control, cardiovascular risk factor reduction, and the effects of accelerated atherosclerosis in the setting of immune suppression.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Stanford University Medical Center, Stanford, CA 94305-5109, USA. andysam@stanford.edu
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Samuelson
authors.forename: Maximilian
authors.initials: M
authors.lastname: Lee
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kamal
authors.forename: Emmet B
authors.initials: EB
authors.lastname: Keeffe
authors.forename: Aijaz
authors.initials: A
authors.lastname: Ahmed
mesh_terms: D000367:Age Factors; D016022:Case-Control Studies; D002423:Cause of Death; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
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