Incidence of New-Onset Diabetes and PostTransplant Metabolic Syndrome after Liver Transplantation - A Prospective Study from South India.

Autor: Oommen T; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Arun CS; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Kumar H; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Nair V; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Jayakumar RV; Consultant Endocrinologist, Aster Medcity, Kochi, Kerala, India., Sudhindran S; Department of Gastro-Intestinal Surgery, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Praveen VP; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Nithya Abraham NB; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India., Menon U; Department of Endocrinology, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
Jazyk: angličtina
Zdroj: Indian journal of endocrinology and metabolism [Indian J Endocrinol Metab] 2020 Mar-Apr; Vol. 24 (2), pp. 165-169. Date of Electronic Publication: 2020 Apr 30.
DOI: 10.4103/ijem.IJEM_602_19
Abstrakt: Background and Aims: Liver transplantation has become an effective therapy for patients with end-stage liver disease. The risk of new-onset diabetes after transplantation (NODAT) and posttransplant metabolic syndrome (PTMS) is high among patients after liver transplantation. These are thought to be associated with increased risks of graft rejection, infection, cardiovascular disease, and death. Our study aimed to document the incidence of NODAT and PTMS and analyze pre and posttransplant predictive factors for their development in patients undergoing a liver transplant.
Methods: This was a prospective comparative study on 51 patients who underwent live donor liver transplantation. They were evaluated at baseline, 3 and 6 months after transplantation with fasting glucose, lipids, serum insulin levels, C-peptide, and HbA1C. They were followed up at 5 years to document any cardiovascular events or rejection.
Results: The incidence of preoperative diabetes mellitus (DM) in the study group was 25/51 (49%). The incidence of NODAT was 38.5% (10/26 patients) and PTMS 29% (10/35), respectively. Age (47.7 ± 5.4 vs 41.5 ± 12.7 years), HOMA2 - IR (2.3 ± 1.8 vs 2.1 ± 1.6), serum insulin (16.1 ± 12.0 vs 17.9 ± 14.5), and C-peptide (4.6 ± 0.5 vs 4.8 ± 0.7) were similar at baseline in the NODAT group compared to those who did not develop it. Mean tacrolimus levels were higher in PTMS group (6.8 ± 2.9 vs 5.0. ± 2.0 P value = 0.042). By the end of 5 years, 7 patients expired; 6 due to rejection and one due to cardiovascular disease. Moreover, 2 of these patients had preexisting DM and 2 had NODAT.
Conclusions: None of the baseline metabolic factors in patients undergoing liver transplant were predictive of the development of NODAT or PTMS. Mean tacrolimus levels were significantly higher in the PTMS group. A 5-year follow-up showed no excess risk of cardiovascular events or rejection in those with preexisting DM or in those who developed NODAT.
Competing Interests: There are no conflicts of interest.
(Copyright: © 2020 Indian Journal of Endocrinology and Metabolism.)
Databáze: MEDLINE
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