title: Effect of pretransplant diabetes on short-term outcomes after liver transplantation: a national cohort study.
abstract: OBJECTIVE
  We sought to analyse the effect of pretransplant diabetes on post-operative outcomes and resource utilization following liver transplantation.
  
  
  METHODS
  A retrospective cohort study was designed using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases. We identified 12 442 patients who underwent liver transplantation at 63 centres from 2007-2011 and separated cohorts of patients with diabetes (n = 2971; 24%) and without (n = 9471; 76%) at the time of transplant. We analysed transplant related outcomes and short-term survival.
  
  
  RESULTS
  Diabetic recipients were more likely to be male (70% vs 67%), non-white (32% vs 26%), older (age ≥60; 41% vs 28%), and have a higher BMI (29 vs 27; P < 0.001). More diabetic patients were on haemodialysis (10% vs 7%), had cirrhosis caused by NASH (24% vs 9%; P < 0.001), and received liver allografts from older donors (≥ 60 years; 19% vs 15%) with a higher donor risk index (>1.49; 46% vs 42%; P < 0.001). Post-transplant, diabetic recipients had longer hospital length of stay (10 vs 9 days), higher peri-transplant mortality (5% vs 4%) and 30-day readmission rates (41% vs 37%), were less often discharged to home (83% vs 87%; P < 0.05), and had inferior graft and patient survival. Liver transplant was more expensive for type 1 vs type 2 diabetics ($105 078 vs $100 624, P < 0.001). Poorly controlled diabetic recipients were less likely discharged home following transplant (75% vs 82%, P < 0.01).
  
  
  CONCLUSIONS
  This national study indicates that pretransplant diabetes is associated with inferior post-operative outcomes and increased resource utilization after liver transplantation.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Singhal
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Flavio
authors.initials: F
authors.lastname: Paterno
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: E
authors.initials: E
authors.lastname: Steve Woodle
authors.affiliation: University Health Consortium and Department Health Systems Management, Rush University, Chicago, IL, USA.
authors.forename: Sam
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000628:therapy*; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000191:economics / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission; D011183:Postoperative Complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: SRTR; UHC; diabetes; liver transplant; outcomes