The aims of our single-center study were to identify whether pretransplant diabetes had an impact on patient survival and, secondly, the predictive factors for development of new-onset diabetes mellitus (NODM) (as defined by American Diabetes Association/World Health Organization).Patients and Methods.
One hundred seventy-nine consecutive adult orthotopic liver-transplant patients were included in this study. Immunosuppression was based on calcineurin inhibitors with steroids, with or without mycophenolate mofetil, and with or without induction therapy. To evaluate the predictive factors for NODM, donor and recipient pre- and posttransplant data were included.Results.
At transplantation, 38 patients had diabetes (group I), and the 141 nondiabetic patients constituted group II. In group I, paternal history of diabetes was more frequent (P=0.03), as was length of exposure to smoking (P=0.03), higher pretransplant glycemia (P<0.001), and shorter cold-ischemia (P=0.027) compared with group II. Pretransplant diabetes in group I resulted in a mortality rate of 39.5% at 1 year compared with 19.1% in group II (P=0.009). In group II, in multivariate analysis, independent predictive factors for NODM at M12 were pretransplant glycemia (P=0.037), alcohol-induced end-stage liver disease (P=0.04), and cumulative steroid dose within 1-year posttransplant (P=0.05).Conclusion.
Of the independent predictive risk factors for NODM, only steroid dose is modifiable, emphasizing the need for individualized immunosuppression.