Burden of Portal Hypertension Complications Is Greater in Liver Transplant Wait-Listed Registrants with End-Stage Liver Disease and Type 2 Diabetes

被引：0

作者：

Yakubu, Idris ^{[1
]}

Flynn, Sean ^{[2
]}

Khan, Hiba ^{[2
]}

Nguyen, Madison ^{[2
]}

Razzaq, Rehan ^{[2
]}

Patel, Vaishali ^{[3
]}

Kumaran, Vinay ^{[4
]}

Sharma, Amit ^{[4
]}

Siddiqui, Mohammad Shadab ^{[3
,5
]}

机构：

[1] Virginia Commonwealth Univ VCU, Dept Pharm, Richmond, VA USA

[2] Virginia Commonwealth Univ VCU, Dept Internal Med, Richmond, VA USA

[3] Virginia Commonwealth Univ, Div Gastroenterol & Hepatol, Sch Med, Richmond, VA 23298 USA

[4] VCU, Div Transplant Surg, Richmond, VA USA

[5] Virginia Commonwealth Univ, POB 980204,1200 East Broad St, Richmond, VA 23298 USA

来源：

DIGESTIVE DISEASES AND SCIENCES | 2024年 / 69卷 / 09期

关键词：

Portal hypertension; End-stage liver disease; Decompensated cirrhosis; Liver associated clinical events; Waitlist mortality; HEPATIC-ENCEPHALOPATHY; NATURAL-HISTORY; CIRRHOSIS; MELLITUS; OUTCOMES; GLUCOSE; RISK;

D O I：

10.1007/s10620-024-08499-2

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and AimsImpact of type 2 diabetes mellitus (T2DM) in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT) remains poorly defined. The objective of the present study is to evaluate the relationship between T2DM and clinical outcomes among patients with LT waitlist registrants. We hypothesize that the presence of T2DM will be associated with worse clinical outcomes.Methods593 patients adult (age 18 years or older) who were registered for LT between 1/2010 and 1/2017 were included in this retrospective analysis. The impact of T2DM on liver-associated clinical events (LACE), survival, hospitalizations, need for renal replacement therapy, and likelihood of receiving LT were evaluated over a 12-month period. LACE was defined as variceal hemorrhage, hepatic encephalopathy, and ascites. Kaplan-Meier and Cox regression analysis were used to determine the association between T2DM and clinical outcomes.ResultsThe baseline prevalence of T2DM was 32% (n = 191) and patients with T2DM were more likely to have esophageal varices (61% vs. 47%, p = 0.002) and history of variceal hemorrhage (23% vs. 16%, p = 0.03). The presence of T2DM was associated with increased risk of incident ascites (HR 1.91, 95% CI 1.11, 3.28, p = 0.019). Patients with T2DM were more likely to require hospitalizations (56% vs. 49%, p = 0.06), hospitalized with portal hypertension-related complications (22% vs. 14%; p = 0.026), and require renal replacement therapy during their hospitalization. Patients with T2DM were less likely to receive a LT (37% vs. 45%; p = 0.03). Regarding MELD labs, patients with T2DM had significantly lower bilirubin at each follow-up; however, no differences in INR and creatinine were noted.ConclusionPatients with T2DM are at increased risk of clinical outcomes. This risk is not captured in MELD score, which may potentially negatively affect their likelihood of receiving LT.

引用

页码：3554 / 3562

页数：9

共 28 条

[1] Glycemic Control Predicts Severity of Hepatocyte Ballooning and Hepatic Fibrosis in Nonalcoholic Fatty Liver Disease [J].