[New-onset diabetes mellitus and liver transplantation, with special consideration of recurrent hepatitis C].
New-onset diabetes is a common complication after liver transplantation.


OBJECTIVE
We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome.


METHODS
We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation.


RESULTS
New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24+/-3 vs. 22.4+/-3.6 kg/m 2 , p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6+/-7.2 vs. 38.3+/-14.6 year, p<0.001), body mass index (26.7+/-3.8 vs. 23.3+/-5.6 kg/m 2 , p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05+/-1.53 vs. 1.00+/-1.08, p = 0.039).


CONCLUSIONS
Risk factors for new-onset diabetes after transplantation are older age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients.
Nemes
Balázs
B
Semmelweis Egyetem, Altalános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest Baross u. 23. 1082. nemes@trans.sote.hu
Gelley
Fanni
F
Zádori
Gergely
G
Földes
Katalin
K
Firneisz
Gábor
G
Görög
Dénes
D
Fehérvári
Imre
I
Kóbori
László
L
Gerlei
Zsuzsanna
Z
Fazakas
János
J
Pápai
Simon
S
Doros
Attila
A
Nagy
Péter
P
Lengyel
Gabriella
G
Schaff
Zsuzsa
Z
Sárváry
Eniko
E
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis / Q000209:etiology; D015994:Incidence; D008103:Liver Cirrhosis / Q000150:complications / Q000821:virology*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D012008:Recurrence; D012307:Risk Factors; D012737:Sex Factors; D016019:Survival Analysis