Published in:
Open Access
01-12-2015 | Research article
Risk of de novo post-transplant type 2 diabetes in patients undergoing liver transplant for non-alcoholic steatohepatitis
Authors:
Maria Stepanova, Linda Henry, Rishi Garg, Shirley Kalwaney, Sammy Saab, Zobair Younossi
Published in:
BMC Gastroenterology
|
Issue 1/2015
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Abstract
Background
Non-alcoholic steatohepatitis (NASH) is often seen together with components of metabolic syndrome. The aim of this study was to assess the risk of de novo post-transplant type 2 diabetes (DM) in liver transplant recipients with NASH.
Methods
All adult patients from the Scientific Registry of Transplant Recipients (2003–2012) transplanted for NASH or cryptogenic cirrhosis (the NASH cohort) without pre-transplant DM were included in this retrospective cross-sectional study.
Results
Total 2,916 NASH subjects and 14,268 controls with non-HCV related cirrhosis or hepatocellular carcinoma were included. Patients with NASH were, on average, 6 years older, more likely female and overweight/obese. By 5 years post-transplant, 39.8 % NASH vs. 27.0 % controls developed at least one onset of de novo DM; this was observed starting 6 months post-transplant: 22.9 % vs. 16.7 % (relative risk 1.38). Later in follow-up, the relative risk of de novo DM was also higher in NASH: 1.46 by 3 years, 1.47 by 5 years (all p < 0.0001). After exclusion of DM that resolved after the first year, long-term DM remained higher in the NASH cohort: 7.6 % vs. 4.3 %, p < 0.0001. In multivariate analysis, after adjustment for confounders including the use of immunosuppressants, having NASH was independently associated with development of de novo post-transplant DM: adjusted hazard ratio (95 % CI) = 1.29 (1.18–1.42), p < 0.0001.
Conclusions
Liver transplant recipients with NASH have a higher risk of de novo post-transplant DM. This suggests the presence of an underlying metabolic disorder beyond fatty liver that may be causative for both NASH and type 2 diabetes.