title: The impact of diabetes mellitus and glycemic control on clinical outcomes following liver transplant for hepatitis C.
abstract: Hepatitis C is the leading indication for liver transplantation in the USA and recurrence is universal. The impact of preexisting diabetes, new-onset diabetes after transplant (NODAT), and glycemic control on fibrosis progression has not been studied. This retrospective longitudinal cohort study included adult liver recipients with hepatitis C transplanted between 2000 and 2011. Patients were divided into three groups: preexisting diabetes (n = 41), NODAT (n = 59), and no diabetes (n = 103). Patients with preexisting diabetes (70%) or NODAT (59%) were more likely to develop hepatitis C recurrence (≥stage 1 fibrosis), as compared to non-diabetics (36%, p = 0.006). There was also a trend toward a higher incidence of at least Stage 2 fibrosis (36% and 48% vs. 23%, respectively; p = 0.063). Patients with tight glycemic control had a lower rate of Stage 2 fibrosis development (78% vs. 60%, p = 0.027), while those with good control (<150 mg/dL) also had lower rates of Stage 2 fibrosis (84% vs. 62%, p = 0.004). Multivariable analysis verified a decreased rate of recurrence for patients with blood glucose <138 mg/dL (p = 0.021), after controlling for confounders. These results demonstrate that diabetes is strongly associated with an increased risk of hepatitis C virus-related fibrosis development and glycemic control may reduce the risk and severity of recurrence.
authors.affiliation: Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Pharmacy Services, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Morbitzer
authors.forename: David J
authors.initials: DJ
authors.lastname: Taber
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Pilch
authors.forename: Holly B
authors.initials: HB
authors.lastname: Meadows
authors.forename: James N
authors.initials: JN
authors.lastname: Fleming
authors.forename: Charles F
authors.initials: CF
authors.lastname: Bratton
authors.forename: John W
authors.initials: JW
authors.lastname: McGillicuddy
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006084:Graft Rejection / Q000175:diagnosis / Q000209:etiology; D006085:Graft Survival; D016174:Hepacivirus / Q000472:pathogenicity; D006526:Hepatitis C / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000503:physiopathology*; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D001786:Blood Glucose
keywords: blood glucose; fibrosis; graft loss; new-onset diabetes after transplant; recurrence