title: Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury.
abstract: OBJECTIVE
  We studied new-onset diabetes after transplantation (NODAT) in liver transplantation with grafts donated after brain death (DBD) or circulatory death (DCD), focusing on the early post-transplant period.
  
  
  METHODS
  A total of 430 non-diabetic primary liver transplant recipients [DCD, n = 90 (21%)] were followed up for 30 months (range 5-69). NODAT was defined as the composite endpoint of one of following: (i) Two non-fasting plasma glucose levels > 11.1 mmol/L ≥ 30 days apart, (ii) oral hypoglycaemic drugs ≥ 30 days consecutively (iii) insulin therapy ≥ 30 days and (iv) HbA1c ≥ 48 mmol/L. Resolution of NODAT was defined as cessation of treatment or hyperglycaemia.
  
  
  RESULTS
  Total of 81/430 (19%) patients developed NODAT. Incidence and resolution of NODAT over time showed significantly different patterns between DCD and DBD liver graft recipients; early occurrence, high peak incidence and early resolution were seen in DCD. In multivariate logistic regression including age, ethnicity, HCV, tacrolimus level and pulsed steroids, only DCD was independently associated with NODAT at day 15 post-transplant (OR 6.5, 95% CI 2.3-18.4, P < 0.001), whereas age and pulsed steroids were significant factors between 30-90 days. Combined in multivariate Cox regression model for NODAT-free survival, graft type, age and pulsed steroids were each independent predictor for decreased NODAT-free survival in the first 90-postoperative days.
  
  
  CONCLUSIONS
  Early peak of NODAT in DCD graft recipients is a novel finding, occurring independently from known risk factors. Donor warm ischaemia and impact on insulin sensitivity should be further studied and could perhaps be associated with graft function.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Hermien
authors.initials: H
authors.lastname: Hartog
authors.affiliation: Diabetes Center, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Christine J H
authors.initials: CJ
authors.lastname: May
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Corbett
authors.affiliation: Diabetes Center, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Angela
authors.initials: A
authors.lastname: Phillips
authors.affiliation: Institute of Biomedical research, University of Birmingham, Birmingham, UK.
authors.forename: Jeremy W
authors.initials: JW
authors.lastname: Tomlinson
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Hynek
authors.initials: H
authors.lastname: Mergental
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: John
authors.initials: J
authors.lastname: Isaac
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Bramhall
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Darius F
authors.initials: DF
authors.lastname: Mirza
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: Paolo
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
authors.forename: M Thamara P R
authors.initials: MT
authors.lastname: Perera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000737:chemistry; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000737:chemistry; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D016031:Liver Transplantation / Q000009:adverse effects* / Q000145:classification; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D066027:Transplant Recipients; D052096:Warm Ischemia / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; C517652:hemoglobin A1c protein, human
keywords: NODAT; diabetes mellitus; donation after circulatory death; hyperglycaemia; liver transplantation