title: The association of hepatitis C virus infection and post-liver transplant diabetes: data from 17 000 HCV-infected transplant recipients.
abstract: BACKGROUND
  Hepatitis C virus (HCV) is associated with metabolic manifestations including insulin resistance and diabetes through various mechanisms. Whether HCV infection is associated with an increased risk of post-transplant diabetes in liver transplant recipients is unclear.
  
  
  OBJECTIVE
  To assess the association of HCV infection with post-transplant diabetes.
  
  
  METHODS
  All liver transplant recipients infected with hepatitis C (exposed) and hepatitis B (HBV) (controls) with post-transplant follow-up from the Scientific Registry of Transplant Recipients (2003-2012) were included.
  
  
  RESULTS
  A total of 17 121 HCV patients and 1450 HBV controls were included in this observational study. Subjects with HCV were more likely to be overweight and obese at transplant, but the rate of pre-transplant diabetes of 13.7% was similar to HBV (P > 0.05). Post-transplant, 32.5% of HCV patients and 27.5% of HBV patients had diabetes (P < 0.0001). This difference was observed starting as early as 6 months post-transplant: 22.5% HCV and 18.9% HBV (P = 0.0043). With longer follow-up, both the cumulative and incidental risks of developing post-transplant diabetes were consistently higher in HCV patients. In particular, by 5 years post-transplant, both the relative risk of having diabetes [1.18 (1.08-1.29), P = 0.0002] and the hazard ratio for time to developing diabetes [1.27 (1.15-1.41), P < 0.0001] were significantly higher in HCV patients compared to HBV patients. In multivariate analysis, after adjustment for confounders including the use of immunosuppressants, hepatitis C infection was independently associated with developing post-transplant diabetes: aHR = 1.55 (1.34-1.79), P < 0.0001.
  
  
  CONCLUSIONS
  Hepatitis C infection is associated with a higher risk of post-transplant diabetes that persists up to 5 years post-transplant.
authors.affiliation: Department of Medicine, Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, USA; Betty and Guy Beatty Center for Integrated Research, Inova Health System, Falls Church, VA, USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Younossi
authors.forename: M
authors.initials: M
authors.lastname: Stepanova
authors.forename: S
authors.initials: S
authors.lastname: Saab
authors.forename: G
authors.initials: G
authors.lastname: Trimble
authors.forename: A
authors.initials: A
authors.lastname: Mishra
authors.forename: L
authors.initials: L
authors.lastname: Henry
mesh_terms: D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D016174:Hepacivirus; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology