Adverse Effects of New-Onset Diabetes After Liver Transplantation

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Conference Proceeding

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Publication Title

Am J Transplant


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]

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Suppl 1

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