Post-transplant diabetes mellitus in liver transplantation:Hangzhou experience

BACKGROUND:Diabetes mellitus(DM)is a frequent and serious complication in patients with liver diseases.We aimed to assess the prevalence and consequences of post- transplant DM(PTDM)in Chinese patients with HBV- related liver diseases and to determine the possible risk factors. METHODS:Altogether 165 patients with HBV infection and undergoing cadaveric related liver transplantation(LT) were enrolled.The clinical data of patients with(PTDM group)and without PTDM(non-PTDM group)were compared.. RESULTS:Of the 165 patients,28 had DM and 12 had impaired fasting glucose(IFG)before LT.Patients with pre-transplant DM or IFG had a survival rate similar to that of the others.Forty patients(24.2%)developed PTDM with a mean time of 36±17 days(range 2-300 days)after LT.Of those,32 developed PTDM within 3 months post-LT and 29 needed insulin treatment.Pre-transplant hepatic encephalopathy and tacrolimus application were found more frequently in the PTDM group than in the non-PTDM group.The plasma tacrolimus levels were notably higher at 1 and 3 months post-LT in the PTDM group than those in the non-PTDM group.Compared to the non-PTDM group, the PTDM group showed remarkably poorer survival and tumor-free survival in patients with hepatocellular carcinoma,and significantly higher incidence of sepsis, fungal infection,chronic kidney diseases and biliary complications after LT.CONCLUSIONS:Pre-transplant DM did not affect the patient survival after LT.Since PTDM is common,it has a negative impact on outcome and may contribute to tumor recurrence.Pre-transplant hepatic encephalopathy,a tacrolimus-based regimen,and high levels of tacrolimus are clearly associated with the occurrence of PTDM.