title: Elevated Fasting Plasma Glucose before Liver Transplantation is Associated with Lower Post-Transplant Survival.
abstract: BACKGROUND The risk of liver cirrhosis is higher among individuals with diabetes mellitus, and a cirrhotic patient with diabetes may have a poorer prognosis after liver transplantation compared to a patient without diabetes. Thus, we evaluated whether fasting plasma glucose prior to receiving a liver transplant was a prognostic factor for post-transplant survival. MATERIAL AND METHODS Ninety-one patients received a living donor liver transplant between November 2005 and December 2012. Patients were considered diabetic if they were prescribed diabetes medications or had impaired glucose tolerance as measured by an oral glucose tolerance test. Each patient was monitored through December 31, 2013, to evaluate prognosis. RESULTS Fasting plasma glucose of at least 100 mg/dL significantly decreased survival following transplant (52% in the high FPG group compared to 78% in the control group, p=0.04), while postprandial hyperglycemia had no effect on survival. Additionally, overall mortality and the incidence of vascular disease were significantly higher among patients with uncontrolled plasma glucose. Impaired fasting plasma glucose was significantly and inversely associated with overall survival in the univariate and multivariate analyses, while creatinine (at least 1 mg/dL) was inversely associated with survival in the univariate analysis. CONCLUSIONS Elevated fasting plasma glucose prior to liver transplantation was inversely associated with post-transplant survival. This effect may be due to underlying microangiopathy as a result of uncontrolled diabetes before transplantation. Our data demonstrated the importance of controlled blood glucose prior to liver transplantation.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Emi
authors.initials: E
authors.lastname: Katsura
authors.affiliation: Department of Gastroenterology, Nagasaki Harbor Medical Center, Nagasaki, Japan
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Ichikawa
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Naota
authors.initials: N
authors.lastname: Taura
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Hisamitsu
authors.initials: H
authors.lastname: Miyaaki
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miuma
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Shibata
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Takuya
authors.initials: T
authors.lastname: Honda
authors.affiliation: Department of Transplantation and Digestive Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hidaka
authors.affiliation: Department of Transplantation and Digestive Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Akihiko
authors.initials: A
authors.lastname: Soyama
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Fuminao
authors.initials: F
authors.lastname: Takeshima
authors.affiliation: Department of Transplantation and Digestive Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Susumu
authors.initials: S
authors.lastname: Eguchi
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of
  Biomedical Sciences, Nagasaki University, Nagasaki, Japan
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D048909:Diabetes Complications / Q000097:blood; D003920:Diabetes Mellitus / Q000097:blood; D005215:Fasting / Q000097:blood*; D005260:Female; D005951:Glucose Tolerance Test; D006085:Graft Survival; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy; D008103:Liver Cirrhosis / Q000097:blood / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose