Alterations in carbohydrate metabolism in cirrhotic patients before and after liver transplant.
OBJECTIVE
The main objective of this study is to demonstrate whether carbohydrate metabolism alterations identified in patients with advanced cirrhosis show any improvement after liver transplant.


METHODS
The study included 86 patients who underwent liver transplant between March 2010 and February 2011. An oral glucose tolerance test was performed before the liver transplant, and 6 and 12 months after. Beta cell function and insulin resistance were also calculated, applying formulae that use basal plasma glycaemia and insulin, and plasma glycaemia and insulin during an oral glucose tolerance test. Risk factors for pre- and post-transplant diabetes were also studied. The diagnosis of diabetes was based on an OGTT.


RESULTS
The proportion of patients with diabetes before transplant, and at month 6 and 12 after transplant were 70.9%, 48.8% and 39.2%, respectively. Compared to baseline, at month 6 the odds ratio of having diabetes was 0.39 (IC 95% [0.21, 0.73]) and at month 12 it was 0.26 (IC 95% [0.14, 0.50]). The composite insulin sensitivity index values at 6 and 12 months were 1.72 units higher (IC 95% [0.84, 2.58]) and 1.58 units higher (IC 95% [0.68, 2.44)] than baseline. A statistically significant association was found between high MELD values and high body mass index, and risk of pre-transplant diabetes (p=0.001 and p=0.033, respectively). Cirrhosis aetiology did not influence the risk of diabetes.


CONCLUSIONS
In this study, we were able to ascertain that alterations in carbohydrate metabolism typical of advanced cirrhosis improve after liver transplant. This improvement is mainly due to an improvement in insulin resistance.
Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Valencia, Spain.
Agustín
A
Ramos-Prol
Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain.
David
D
Hervás-Marín
Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Beatriz
B
Rodríguez-Medina
Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Vicente
V
Campos-Alborg
Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Marina
M
Berenguer
Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
Ángel
Á
Moya-Herraiz
Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain. Electronic address: merino_jfr@gva.es.
Juan Francisco
JF
Merino-Torres
D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D050260:Carbohydrate Metabolism / Q000502:physiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007328:Insulin
Carbohydrate metabolism; Diabetes; Insulin resistance; Liver cirrhosis; Liver transplantation