title: Risk of de novo post-transplant type 2 diabetes in patients undergoing liver transplant for non-alcoholic steatohepatitis.
abstract: BACKGROUND
  Non-alcoholic steatohepatitis (NASH) is often seen together with components of metabolic syndrome. The aim of this study was to assess the risk of de novo post-transplant type 2 diabetes (DM) in liver transplant recipients with NASH.
  
  
  METHODS
  All adult patients from the Scientific Registry of Transplant Recipients (2003-2012) transplanted for NASH or cryptogenic cirrhosis (the NASH cohort) without pre-transplant DM were included in this retrospective cross-sectional study.
  
  
  RESULTS
  Total 2,916 NASH subjects and 14,268 controls with non-HCV related cirrhosis or hepatocellular carcinoma were included. Patients with NASH were, on average, 6 years older, more likely female and overweight/obese. By 5 years post-transplant, 39.8% NASH vs. 27.0% controls developed at least one onset of de novo DM; this was observed starting 6 months post-transplant: 22.9% vs. 16.7% (relative risk 1.38). Later in follow-up, the relative risk of de novo DM was also higher in NASH: 1.46 by 3 years, 1.47 by 5 years (all p < 0.0001). After exclusion of DM that resolved after the first year, long-term DM remained higher in the NASH cohort: 7.6% vs. 4.3%, p < 0.0001. In multivariate analysis, after adjustment for confounders including the use of immunosuppressants, having NASH was independently associated with development of de novo post-transplant DM: adjusted hazard ratio (95% CI) = 1.29 (1.18-1.42), p < 0.0001.
  
  
  CONCLUSIONS
  Liver transplant recipients with NASH have a higher risk of de novo post-transplant DM. This suggests the presence of an underlying metabolic disorder beyond fatty liver that may be causative for both NASH and type 2 diabetes.
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Maria.Stepanova@inova.org.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA, 22042, USA. Maria.Stepanova@inova.org.
authors.forename: Maria
authors.initials: M
authors.lastname: Stepanova
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Linda.Henry@inova.org.
authors.forename: Linda
authors.initials: L
authors.lastname: Henry
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Rishi.Garg@inova.org.
authors.forename: Rishi
authors.initials: R
authors.lastname: Garg
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. Shirley.Kalwaney@inova.org.
authors.forename: Shirley
authors.initials: S
authors.lastname: Kalwaney
authors.affiliation: Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, CA, USA. SSaab@mednet.ucla.edu.
authors.forename: Sammy
authors.initials: S
authors.lastname: Saab
authors.affiliation: Center for Liver Diseases, Department of Medicine, Inova Fairfax Hospital, Falls Church, VA, USA. zobair.younossi@inova.org.|Betty and Guy Beatty Center for Integrated Research, Inova Health System, Claude Moore Health Education and Research Building, 3rd floor, 3300 Gallows Road, Falls Church, VA, 22042, USA. zobair.younossi@inova.org.
authors.forename: Zobair
authors.initials: Z
authors.lastname: Younossi
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications / Q000209:etiology / Q000601:surgery*; D009765:Obesity / Q000150:complications; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors