New-onset diabetes mellitus (NODM) develops in certain patients following a liver transplant. A new study on risk factors that cause NODM to develop, finds that all the risk factors can be detected before a transplant is done and treatment should be tailored to the patient's risk
They found the risk factors - a history of obesity, impaired fasting glucose and hepatitis C infection (HCV) paired with the use of a particular immunosuppressant- increase risk of NODM.
The results of this study appear in the January 2007 issue of Liver Transplantation, the official journal of the American Association for the Study of Liver Diseases (AASLD) and the International Liver Transplantation Society (ILTS). The journal is published on behalf of the societies by John Wiley & Sons, Inc. and is available online via Wiley InterScience at http:www.interscience.wiley.com/journal/livertransplantation.
The development of NODM after a liver transplant is associated with increased cardiovascular disease and death, a higher incidence of rejection, more infections and reduced quality of life. It is therefore likely that the survival rate following liver transplant could be improved by reducing the incidence of NODM. However, the exact incidence of NODM is not clear because existing studies have used varying criteria. In addition, no definitive risk factors have been clearly established. Immunosuppressive drugs are known to contribute to diabetes, although this effect varies depending on the drug; calcineurine inhibitors are less likely to cause diabetes than steroids.
Led by Faouzi Saliba, M.D. of the Hôpital Paul Brousse in Villejuif, France, the study included 211 patients from 10 transplant centers in France who had undergone a liver transplant between October 2003 and June 2004. Patients' clinical records were reviewed and their fasting blood glucose levels were recorded 3, 6, 12 and 18 months after undergoing the transplant. For those with NODM, the date of diagnosis was noted, along with the immunosuppressive treatment and diabetes management they had received.
The results showed an incidence of NODM of 22.7 percent, with the majority of the cases diagnosed within three months of transplant. In addition, 12.4 percent of the patients with normal glucose levels before transplant developed impaired fasting glucose (IFG). The risk factors for developing NODM included HCV infection (especially when combined with the immunosuppressant tacrolimus), IFG prior to the transplant, and a history of clinical obesity. In addition, the presence of at least two cardiovascular risk factors and a history of either gestational diabetes or having given birth to a baby weighing over 4 kilograms also increased the risk of NODM. The authors note that since abnormal glucose regulation prior to transplantation has been implicated as a possible risk factor of NODM and IFG emerged as a strong predictor of the condition in the current study, pre-transplantation glucose screening may be important in helping to predict NODM.
'Our study suggests that it may eventually be possible to derive a composite risk factor equation for the development of NODM following liver transplantation with appropriate weighing for each variable, perhaps similar to the risk assessment instruments developed for the primary prevention of cardiovascular disease,' the authors conclude.