Adverse Effects of New-Onset Diabetes After Liver Transplantation

Document Type

Conference Proceeding

Publication Date

6-1-2023

Publication Title

Am J Transplant

Keywords

corticosteroid, tacrolimus, adult, cardiovascular disease, cholestasis, clinical feature, conference abstract, controlled study, diabetes mellitus, female, graft failure, human, human cell, human tissue, immunosuppressive treatment, incidence, liver transplantation, lung complication, major clinical study, male, outcome assessment, overall survival, risk factor, surgery

Abstract

Purpose: While diabetes is considered as a risk factor for poor outcomes after liver transplantation (LT), the impact of new-onset diabetes after LT (NODAT) on post-transplant outcomes remains to be elucidated. The aims of this study are to identify the clinical characteristics of NODAT and to investigate its impacts on post-transplant outcomes. Methods: Adult patients underwent LT at our center between 2014 and 2020 were evaluated. Inclusion criteria include use of tacrolimus as initial immunosuppression regimen and those who survived 3 months at least post-LT. To evaluate possible impact of NODAT on post-LT outcomes, those who developed NODAT within 3 months after LT were classified as NODAT group. In addition, patients were further classified into the following 2 groups; prior history of diabetes before LT (PHDBT) and non-diabetes (ND) groups. Patient characteristics of NODAT and post-LT conditional outcomes after 3 months, and cardiovascular and/or pulmonary complications, were compared. Results: A total of 83 and 225 and 263 patients were classified into NODAT, PHDBT, and ND groups. The proportion of cholestatic liver disease (21.7, 5.3, and 12.9%, P<0.001) and rejection within 30 days (42.2, 7.1, and 4.6%, P<0.001) in NODAT, PHDBT, and ND, respectively. Mean serum tacrolimus concentration trough level in the first week after LT was 7.12, 6.12, and 6.12 ng/ml in these 3 groups, respectively (P<0.001). Duration of corticosteroids were significantly longer in NODAT (416 days) compared to PHDBD (289 days) or ND (228 days) (P<0.001). (Table 1). Three-year graft and patient survival after 3 months were significantly worse in NODAT than in ND (Graft: 80.5% vs. 95.0%, P<0.001, Patient: 82.0% vs. 95.4%, P<0.001) but similar to PHDBT (Figures 1 and 2). Adjusted risk of 3-year graft loss and patient death were significantly higher in NODAT compared to ND (Graft; adjusted hazard ratio [aHR] 3.41, p=0.004, Patient; aHR 3.61, p=0.004). Incidence rates of cardiovascular or pulmonary complications after LT in NODAT were significantly higher than in ND (Cardiovascular; 16.9% vs. 3.8%, P<0.001; Pulmonary; 20.5% vs. 11.0%, P=0.04,) but similar to PHDBT (Cardiovascular vs. 16.9%, P=0.99; Pulmonary vs. 20.0%, P=0.99). Conclusions: Cholestatic liver disease, high tacrolimus concentration, and early rejection might be risk factors for NODAT. NODAT was associated with the worse long-term outcomes and increases risk of cardiovascular and/or pulmonary complications. CITATION INFORMATION: Shimada S., Miyake K., Venkat D., Gonzalez H., Moonka D., Rizzari M., Yoshida A., Abouljoud M., Nagai S. Adverse Effects of New-Onset Diabetes After Liver Transplantation AJT, Volume 23, Issue 6, Supplement 1. DISCLOSURES: S.Shimada: None. K.Miyake: None. D.Venkat: n/a. H.Gonzalez: n/a. D.Moonka: None. M.Rizzari: None. A.Yoshida: n/a. M.Abouljoud: None. S.Nagai: None. [Figure presented]

PubMed ID

Not assigned.

Volume

23

Issue

Suppl 1

First Page

S1006

Last Page

S1007

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