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Abstract
Background:
The leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Diabetes mellitus (DM) is one of the greatest contributing factors to these late events, but also one of the most modifiable. This study was conducted to identify the incidence and time course of posttransplant diabetes mellitus (PTDM) after liver transplantation (LT) and evaluate the factors related to the development and reversal of PTDM.
Methods:
Patients who underwent LT between 2002 and 2015 at Ulsan University Hospital, were followed for more than 3 months and had no history of preoperative DM were the subject of this study. The authors investigated the incidence and time course of PTDM. Recipient factors, donor factors and postoperative factors presumed to contribute to the development and reversal of PTDM were investigated. Moreover, the effects of PTDM on the survival of liver transplant recipients were also investigated.
Results:
PTDM developed in 13 (16.5%) of 79 patients who fulfilled the inclusion criteria a median of 35 days after LT. There were no significant factors contributing to the development of PTDM. Five of the 13 PTDM patients recovered from the diabetic condition 5 to 38 months after the diagnosis of PTDM. Higher postoperative magnesium levels (P=0.022), development of acute cellular rejection (P=0.01), and steroid pulse therapy (P=0.045) were the predictive factors for reversal of PTDM. PTDM had no impact on patient survival (P=0.529).
Conclusions:
PTDM usually developed soon after LT operation and was reversible in 41% of the cases, especially when it is associated with steroid pulse therapy for acute cellular rejection. The association between serum magnesium level and reversibility of PTDM after LT needs further study to clarify the cause-and-effect relationship.
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Fig. 1.
Eligibility and enrollment of the patient. Abbreviations: UUH, Ulsan University Hospital; DM, diabetes mellitus.
Fig. 3.
Cumulative survival curves according to the presence of posttransplant diabetes mellitus (PTMD).
Table 1.
Factors associated with the development of PTDM
Data are presented as mean±SD or number (%).
Abbreviations: PTDM, posttransplant diabetes mellitus; BMI, body mass index; DM, diabetes mellitus; MELD, Model for End-Stage Liver Disease; CTP, Child-Turcott-Pugh; HCV, hepatitis C virus; HCC, hepatocellular carcinoma; OP, operation; DDLT, deceased donor liver transplantation; CsA, cyclosporine; POD, postoperative day; Mg, magnesium.
Table 2.
Factors associated with reversibility of PTDM
Data are presented as mean±SD or number (%).
Abbreviations: PTDM, posttransplant diabetes mellitus; BMI, body mass index; DM, diabetes mellitus; HCV, hepatitis C virus; HCC, hepatocellular carcinoma; OP, operation; DDLT, deceased donor liver transplantation; CsA, cyclosporine; POD, postoperative day; Mg, magnesium.
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