title: New-onset diabetes after liver transplantation and its impact on complications and patient survival.
abstract: BACKGROUND
  The aim of the present study was to investigate the incidence and risk factors of new-onset diabetes after transplantation (NODAT) in liver transplant recipients and the influence of NODAT on complications and long-term patient survival.
  
  
  METHODS
  We examined 438 patients who underwent liver transplantation between April 2001 and December 2008 and were not diabetic before transplantation.
  
  
  RESULTS
  The mean (± SD) follow-up duration was 2.46 ± 1.62 years. The incidence of NODAT 3, 6, 9, 12, 36, and 60 months after transplantation was 44.24%, 25.59%, 23.08%, 25.17%, 17.86%, and 18.18%, respectively. Multifactor analysis indicated that preoperative fasting plasma glucose (FPG) levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an interleukin-2 receptor (IL-2R) antagonist reduced the risk of NODAT. Compared with the no NODAT group (N-NODAT), the NODAT group had a higher rate of sepsis and chronic renal insufficiency. Mean survival was significantly longer in the N-NODAT than NODAT group. Cox regression analysis showed that pre- and/or postoperative FPG levels, tumor recurrence or metastasis, and renal insufficiency after liver transplantation were independent risk factors of mortality. Pulmonary infection or multisystem failure were specific causes of death in the NODAT group, whereas patients in both groups died primarily from tumor relapse or metastasis.
  
  
  CONCLUSIONS
  Preoperative FPG levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an IL-2R antagonist reduced the risk of NODAT. Patients with NODAT had reduced survival and an increased incidence of sepsis and chronic renal insufficiency. Significant causes of death in the NODAT group were pulmonary infection and multisystem failure.
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Chaoyang
authors: C
authors: Lv
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Yao
authors: Y
authors: Zhang
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.|Department of Endocrinology and Metabolism, Hainan Provincial Nong Ken Hospital, Hainan, China.
authors: Xianying
authors: X
authors: Chen
authors: Department of Liver Surgery, Zhongshan Hospital, Shanghai, China.
authors: Xiaowu
authors: X
authors: Huang
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Mengjuan
authors: M
authors: Xue
authors: Department of Liver Surgery, Zhongshan Hospital, Shanghai, China.
authors: Qiman
authors: Q
authors: Sun
authors: Department of Liver Surgery, Zhongshan Hospital, Shanghai, China.
authors: Ting
authors: T
authors: Wang
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Jing
authors: J
authors: Liang
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Shunmei
authors: S
authors: He
authors: Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, Shanghai, China.
authors: Jian
authors: J
authors: Gao
authors: Department of Liver Surgery, Zhongshan Hospital, Shanghai, China.
authors: Jian
authors: J
authors: Zhou
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Mingxiang
authors: M
authors: Yu
authors: Department of Liver Surgery, Zhongshan Hospital, Shanghai, China.
authors: Jia
authors: J
authors: Fan
authors: Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
authors: Xin
authors: X
authors: Gao
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002423:Cause of Death; D016009:Chi-Square Distribution; D002681:China / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D005215:Fasting / Q000097:blood; D005234:Fatty Liver / Q000150:complications; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D065840:Protective Factors; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007166:Immunosuppressive Agents; D053590:Interleukin 1 Receptor Antagonist Protein
keywords: fasting plasma glucose; liver transplantation; new-onset diabetes after transplant; postoperative complications; 关键词：空腹血糖，肝移植，移植后新发糖尿病，术后并发症