The impact of type 2 diabetes and obesity on the long‐term outcomes of more than 85 000 liver transplant recipients in the US. Issue 6 (16th July 2014)

• Record Type: Journal Article
• Authors: Younossi, Z. M.; Stepanova, M.; Saab, S.; Kalwaney, S.; Clement, S.; Henry, L.; Frost, S.; Hunt, S.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 40:Issue 6(2014)
• Page Start: 686
• Page End: 694
• Publication Date: 2014-07-16
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12881
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" id="apt12881-abs-0001"> <title>Summary</title> <sec id="apt12881-sec-0001" sec-type="section"> <title>Background</title> <p>Type 2 diabetes is known to negatively impact the outcome of chronic liver disease.</p> </sec> <sec id="apt12881-sec-0002" sec-type="section"> <title>Aim</title> <p>To evaluate the impact of diabetes on the outcomes of liver transplants (LT).</p> </sec> <sec id="apt12881-sec-0003" sec-type="section"> <title>Methods</title> <p>Study cohort included adults (>18 years) who received LT in the US between 1994 and 2013 (The Scientific Registry of Transplant Recipients). Pre‐ and post‐transplant diabetes was recorded in patients with mortality follow‐up.</p> </sec> <sec id="apt12881-sec-0004" sec-type="section"> <title>Results</title> <p>We included 85 194 liver transplant recipients. Of those, 11.2% had history of pre‐transplant diabetes. The most common indications for liver transplant were hepatitis C (36.4%), alcohol‐related liver disease (20.6%), primary liver malignancy of unspecified aetiology (14.7%), cryptogenic cirrhosis (8.0%), hepatitis B (4.6%) and non‐alcoholic steatohepatitis (3.9%). A total of 96.5% transplants were from deceased donors, and 7.9% donors had history of diabetes. During an average 6.5 years of follow‐up, 31.3% recipients died and 8.8% had a graft failure. In multivariate survival analysis [at least 5 years of cohort follow‐up (<italic>N</italic> = 35 870)], after adjustment for age, ethnicity, insurance type, history of chronic diseases, HCV infection and noncompliance, independent predictors of recipient mortality included the presence of pre‐transplant diabetes [adjusted hazard ratio (95%CI) = 1.21 (1.12–1.30)] and developing diabetes post‐transplant [1.06 (1.02–1.11)]. Donor's history of diabetes was also independently associated with higher mortality [1.10 (1.02–1.19)]. Furthermore, donor's history of diabetes was also associated with an increased the risk of liver graft failure [1.35 (1.24–1.47)].</p> </sec> <sec id="apt12881-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Presence of type 2 diabetes pre‐ and post‐transplant, as well as presence of type 2 diabetes in the donors, are all associated with an increased risk of adverse post‐transplant outcomes.</p> </sec> </abstract>