De novo diabetes és májátültetés, különös tekintettel a hepatitis C-vírus kiújulására

Translated title of the contribution: New-onset diabetes mellitus after liver transplantation

Balázs Nemes, Fanni Gelley, Gergely Zádori, Katalin Földes, Gábor Firneisz, Dénes Görög, Imre Fehérvári, László Kóbori, Zsuzsanna Gerlei, János Fazakas, Simon Pápai, Attila Doros, Péter Nagy, Gabriella Lengyel, Zsuzsa Schaff, Eniko Sárváry

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Abstract

New-onset diabetes is a common complication after liver transplantation. Aim: We aimed to analyze the incidence and rate of known risk factors and the impact of new-onset diabetes mellitus on postoperative outcome. Methods: We retrospectively evaluated the files of 310 patients who underwent liver transplantation between 1995 and 2009. Definition of new-onset diabetes included: repeated fasting serum glucose >6.8 mmol/l and/or sustained antidiabetic therapy that was present 3 months after transplantation. Results: New-onset diabetes occurred in 63 patients (20%). Differences between the new-onset and the control group were the donor body mass index (24±3 vs. 22.4±3.6 kg/m2, p = 0.003), donor male gender (58% vs. 33%, p = 0.002), and recipient age (47.6±7.2 vs. 38.3±14.6 year, p<0.001), body mass index (26.7±3.8 vs. 23.3±5.6 kg/m 2, p<0.001), male gender (60% vs. 44%, p = 0.031). The 66% of patients with new-onset diabetes were transplanted with cirrhosis caused by hepatitis C virus infection, while in the control group the rate was 23% (p<0.001). Cumulative patient survival rates at 1, 3, 5 and 8 year were 95%, 90.6%, 88% and 88% in the control group, and 87%, 79%, 79% and 64% in the de novo group, respectively (p = 0.011). Cumulative graft survival rates at 1, 3, 5 and 8 year in the control group were 92%, 87%, 86% and 79%, in the de novo diabetes group the rates were 87%, 79%, 79%, 65%, respectively (p = NS). In case of early recurrence (in 6 months), majority of patients developed new-onset diabetes (74% vs. control 26%, p = 0.03). More patients had more than 10 times higher increase of the postoperative virus titer correlate to the preoperative titer in the de novo diabetes group (53% vs. 20%, p = 0.028). Mean fibrosis score was higher in new-onset group one year after the beginning of antiviral therapy (2.05±1.53 vs. 1.00±1.08, p = 0.039). Conclusions: Risk factors for new-onset diabetes after transplantation are elder age, obesity, male gender and cirrhosis due to hepatitis C infection. The early recurrence, viremia and more severe fibrosis after antiviral therapy have an impact on the occurrence of new-onset diabetes in hepatitis C positive patients.

Original languageHungarian
Pages (from-to)1062-1071
Number of pages10
JournalOrvosi hetilap
Volume151
Issue number26
DOIs
Publication statusPublished - Jun 1 2010

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ASJC Scopus subject areas

  • Medicine(all)

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