1315-P: Pre– and Post–Liver Transplant Diabetes (DM) and Prediabetes (PD), and the Impact on Transplant Outcomes—Results of a Large Single-Center Study

Introduction & Objective: Discussion is still ongoing on the prevalence and characteristics of DM and PD (IFG and/or IGT) in patients before (pre-Tx) and after (post-Tx) liver transplantation (LT), and the impact on post-Tx outcomes.

Methods: In this single center study we evaluated 1,468 patients [(age: 56±9 yrs; M/F: 1107/361; BMI: 24.4±5.8 Kg/m²; family history of diabetes (FHD): 37%; FPG: 109±36 mg/dl; HbA1c: 35±12 mmol/mol); main indications for LT: 57.7% HCV/HBV-related cirrhosis/HCC, and 27.5% dysmetabolic/esotoxic cirrhosis/HCC)] being waitlisted for LT from brain dead donors.

Results: Based on pre-Tx history, FPG, HbA1c and/or OGTT, 32.5% patients had DM and 21.4% PD, with the remaining 46.1% being normoglycemic (NG). DM and PD patients were older and predominantly males (both p<0.001). Furthermore, DM subjects had higher BMI and FHD than PD and NG (both p<0.050). From this cohort, 1,086 subjects underwent LT, 470 of which reaching a 5-year follow-up. In these latter, patient and graft survival was respectively 84.5% and 84.1%, and the prevalence of DM and PD increased respectively to 49% (p<0.001) and 29% (p=0.053) vs Pre-Tx. To identify pre-Tx factors in NG associated with post-Tx DM, machine learning algorithms (both interpretable and explainable) were used (i.e. decision trees, explainable boosting machines and CatBoost) to assess multivariate correlations. Inspection of the models indicated that pre-Tx FPG, BMI, smoking and eGFR were some of the main factors correlated with post-Tx DM. In addition, duration of pre-Tx DM (p=0.051) and HbA1c (p=0.094) tended to impact on patient survival and/or graft outcome.

Conclusion: This accurate assessment of glycemic status of subjects waitlisted for LT implements previous available data and demonstrates a very high prevalence of DM and PD (> 50%); it also identifies modifiable factors to possibly prevent post-Tx DM; duration of pre-Tx DM and its control could affect post-Tx outcomes.