title: Outcomes in patients with diabetes 10 years after liver transplantation.
abstract: BACKGROUND
  There are discrepancies between studies regarding the effect of diabetes mellitus on morbidity and mortality in patients undergoing liver transplantation. The aim of the present study was to compare mortality, risk of liver graft rejection, and cardiovascular events in patients with and without diabetes undergoing liver transplantation over a 10-year follow-up period.
  
  
  METHODS
  A retrospective study was performed on 183 patients who underwent liver transplantation in 2005 and 2006. Mortality and morbidity data were collected until 2016, including information on mortality and survival time, graft rejection and graft survival time, coronary heart disease, stroke, and peripheral arterial ischemia.
  
  
  RESULTS
  During the follow-up, 41.3% and 27.8% of patients in the groups with and without diabetes, respectively, died. A trend for lower survival time was observed in patients with diabetes, although this effect was not confirmed by the Cox regression model. There was an increased risk of graft rejection in the group with diabetes compared with the group without diabetes ( P  < 0.001). In the survival analysis, diabetes was associated with reduced graft survival time ( P  = 0.001). Cardiovascular events were also more likely in the group with diabetes ( P  = 0.005).
  
  
  CONCLUSIONS
  In the present study diabetes was associated with a higher risk of liver graft rejection and cardiovascular events. There was also a trend for higher mortality, although the effect was not statistically significant. These findings suggest that patients with diabetes require a more rigorous pretransplant evaluation and closer monitoring after transplantation in order to try to reduce associated complications.
authors.affiliation: Department of Internal Medicine (Endocrinology and Nutrition), Francesc de Borja Hospital, Gandía, Spain.|Joint Research Unit of Endocrinology, Nutrition and Clinical Dietetics, Valencia, Spain.
authors.forename: Agustín
authors.initials: A
authors.lastname: Ramos-Prol
authors.affiliation: Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Hervás-Marín
authors.affiliation: Endocrinology and Nutrition Department, University and Polytechnic La Fe Hospital, Valencia, Spain.
authors.forename: Alia
authors.initials: A
authors.lastname: García-Castell
authors.affiliation: Joint Research Unit of Endocrinology, Nutrition and Clinical Dietetics, Valencia, Spain.|Endocrinology and Nutrition Department, University and Polytechnic La Fe Hospital, Valencia, Spain.
authors.forename: Juan F
authors.initials: JF
authors.lastname: Merino-Torres
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006084:Graft Rejection / Q000503:physiopathology; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000503:physiopathology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D013997:Time Factors
keywords: cardiovascular events; diabetes; graft rejection; liver transplantation; 心血管事件; 移植排斥; 糖尿病; 肝脏移植