PTH-104 The increasing burden of diabetes on the scottish liver transplantation service

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Abstract

Introduction

In Scotland 65% of adults are overweight and 29% obese1. Among the health implications is a rising prevalence of diabetes within the population. Diabetes is known to contribute to liver damage, including carcinogenesis, and this study seeks to establish the impact of this damage on liver disease, hepatocellular carcinoma (HCC) and need for transplantation within Scotland. Diabetes, as a major risk factor for non-alcoholic fatty liver disease (NAFLD) could also be considered a surrogate marker for the NAFLD component of liver damage in other primary aetiologies.

Methods

Prospectively held patient data from all transplant assessments undertaken at the Scottish liver transplant unit (SLTU) since 1992 were retrospectively analysed for the presence of diabetes, HCC and the underlying aetiology of their liver disease. Data were collected through VitalData (©Vitalpulse Ltd) and exported into Microsoft Excel (©Microsoft) for analysis.

Results

In 1993 there were 45 assessments, which rose to 214 assessments in 2015, giving a total of 3098 during this time frame (figure 1).

Results

The incidence of diabetes in patients referred for liver transplant remained persistently bellow 5% until 2004, from which point it started to increase to 24% in 2016 (figure 2).

Results

Figure 3 shows the percentages of patients who are referred for transplant assessment with HCC who were diabetic at the time of referral.

Results

12.0% of the 3098 patients referred had diabetes, this varied depending on their underlying aetiology- NAFLD (41.9%), ALD (13.5%), cryptogenic cirrhosis (9.6%), HCV (9.2%) and PBC (2.6%). The percentage of patients with diabetes and HCC referred was 18.5% (of 574 patients)- NALFD (45.7%), haemochromatosis (37.2%), ALD (19.1%), PSC (16.7%), HBV (12.5%), HCV (9.9%) and others (0%) (figure 4).

Conclusions

The number of assessments has been increasing since the beginning of transplantation at the SLTU in 1992 with an increasing proportion diabetic. The impact is most clear through the trend in NAFLD reaching transplantation but the prevalence in other aetiologies of liver damage suggests a compound effect.

Conclusions

With the exception of PBC, each of the most common aetiologies seen showed a higher prevalence of diabetes in the patients referred with HCC. This suggests that diabetes promotes carcinogenesis, with the more modest impact in HCV mirroring previous studies into the carcinogenicity of diabetes2.

Conclusions

The increasing incidence of diabetes in patients being referred for transplant assessment with decompensated liver disease or HCC suggests that the national burden of diabetes and NAFLD3 will contribute to an increasing burden of liver damage of almost any aetiology.

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