Effect of pretransplant diabetes on short‐term outcomes after liver transplantation: A National cohort study. (21st January 2015)

• Record Type: Journal Article
• Authors: Hoehn, Richard S.; Singhal, Ashish; Wima, Koffi; Sutton, Jeffrey M.; Paterno, Flavio; Steve Woodle, E.; Hohmann, Sam; Abbott, Daniel E.; Shah, Shimul A.
• Is Part Of: Liver international. Volume 35:Number 7(2015:Jul.)
• Page Start: 1902
• Page End: 1909
• Publication Date: 2015-01-21
• Subjects: Liver -- Periodicals; Liver -- Diseases -- Periodicals; 616.362
• DOI: 10.1111/liv.12770
• Languages: English
• ISSNs: 1478-3223

Abstract

<abstract abstract-type="main" id="liv12770-abs-0001"> <title>Abstract</title> <sec id="liv12770-sec-0001" sec-type="section"> <title>Background & Aims</title> <p>We sought to analyse the effect of pretransplant diabetes on post‐operative outcomes and resource utilization following liver transplantation.</p> </sec> <sec id="liv12770-sec-0002" sec-type="section"> <title>Methods</title> <p>A retrospective cohort study was designed using a linkage between the University HealthSystem Consortium and Scientific Registry of Transplant Recipients databases. We identified 12 442 patients who underwent liver transplantation at 63 centres from 2007–2011 and separated cohorts of patients with diabetes (<italic>n</italic> = 2971; 24%) and without (<italic>n</italic> = 9471; 76%) at the time of transplant. We analysed transplant related outcomes and short‐term survival.</p> </sec> <sec id="liv12770-sec-0003" sec-type="section"> <title>Results</title> <p>Diabetic recipients were more likely to be male (70% vs 67%), non‐white (32% vs 26%), older (age ≥60; 41% vs 28%), and have a higher BMI (29 vs 27; <italic>P</italic> < 0.001). More diabetic patients were on haemodialysis (10% vs 7%), had cirrhosis caused by NASH (24% vs 9%; <italic>P</italic> < 0.001), and received liver allografts from older donors (≥ 60 years; 19% vs 15%) with a higher donor risk index (>1.49; 46% vs 42%; <italic>P</italic> < 0.001). Post‐transplant, diabetic recipients had longer hospital length of stay (10 vs 9 days), higher peri‐transplant mortality (5% vs 4%) and 30‐day readmission rates (41% vs 37%), were less often discharged to home (83% vs 87%; <italic>P</italic> < 0.05), and had inferior graft and patient survival. Liver transplant was more expensive for type 1 vs type 2 diabetics ($105 078 vs $100 624, <italic>P</italic> < 0.001). Poorly controlled diabetic recipients were less likely discharged home following transplant (75% vs 82%, <italic>P</italic> < 0.01).</p> </sec> <sec id="liv12770-sec-0004" sec-type="section"> <title>Conclusions</title> <p>This national study indicates that pretransplant diabetes is associated with inferior post‐operative outcomes and increased resource utilization after liver transplantation.</p> </sec> </abstract>