Background and Aims: There are few data related to identification of risk factors for post transplant diabetes mellitus (PTDM) in liver transplantation (Tx). The aim of this study was to investigate the risk factors for PTDM.
Patients and methods: A retrospective study of adult patients submitted to liver Tx. Data for sex, age, BMI, pre and PTDM, Tx cause, presence of hepatocellular carcinoma (HCC), use of immunosuppressants, hepatitis B, hepatitis C (HepC) and liver biopsy were analyzed. Mann-Whitney and Chi Square tests as well as a multivariate logistic regression were performed.
Results: Among 207 consecutive patients, 60.4% had no diabetes (group 1), 18.8% had pre Tx DM (group 2) and 20.8% were classified as PTDM (group 3). The major cause of transplantation was HepC (48.8%). Triglycerides (164 vs. 106mg/dL, p= 0.002) and creatinine (1.24 vs. 1.1mg/dL, p = 0.029) were higher in group 2 than in group 1, probably due to long-standing DM and metabolic syndrome in group 2. Comparisons using the Chi-Square test showed higher frequencies in group 3 than group 1 and 2, respectively, for HepC (65.1% vs. 35.1% and 37.9%, p=0.004), tacrolimus use (95.3% vs. 81.6% and 71.1%, p<0.001) and prednisone use (48.8% vs. 24% and 36.8%, p=0.009). HCC before Tx was more common in group 2 than in groups 1 and 3 (64.1% vs. 40.8% and 41.9%, respectively; p=0.034). Regarding biopsy data, interface activity was more severe in groups 1 and 3 compared to group 2 (62.2% and 64%% vs. 11%; p=0.040, respectively). The independent risk factors for PTDM according to the multivariate logistic model were HepC (OR 4.4; CI 95% 1.73-11.22; p=0.002), alcoholism (OR = 3.7, 95% CI, 1.2-11.5, p = 0.025), the use of tacrolimus (OR = 6.3, 95% CI 1.2-32.5, p = 0.029) and prednisone (OR = 7.2, 95% CI 2.4-21.8, p<0.001).
Conclusion: Alcohol-related liver disease is an independent risk factor for PTDM in liver recipients. Patients with HepC and those exposed to tacrolimus and prednisone are other groups of high risk for PTDM.
M.B. Campos: None. I.D. Boin: None. A.M. Neto: None.