Abstract - Basic and Clinical Science

Topic: Diagnosis and classification

Abstract title
Incidence and risk factors for new onset diabetes after liver transplantation in a hospital of Buenos Aires.

Co-authors	
J.N. Giunta1, C.S. Bermudez2, S. Marciano3, C.J. Rodriguez1, M.E. Gullace1, V.L. Pagotto4, M.M. Castex1, L.I. Capurro1, A.M. Alvarez1, D.H. Giunta4, A.C. Gadano3, L.A. Grosembacher1.
1Hospital Italiano de Buenos Aires, Endocrinology, CABA, Argentina.
2Hospital Italiano de Buenos Aires, Hepatology, Buenos Aires, Argentina.
3Hospital Italiano de Buenos Aires, Hepatology and Department of Clinical Research, Buenos Aires, Argentina.
4Hospital Italiano de Buenos Aires, Department of Clinical Research, Buenos Aires, Argentina.

Background
New onset diabetes after liver transplantation is a frequent complication related to the type of immunosuppression, frequency of rejection, recurrence of virus C, cytomegalovirus infection and hypomagnesemia. 

Aim
To estimate the incidence of new onset diabetes after liver transplantation and to identify factors associated with its development.

Method
Retrospective cohort study of patients with liver transplantation between January 2011 and December 2013. Exclusion criteria: diagnosis of diabetes prior to transplantation, re-transplantation and combined transplantation. The diagnostic criteria of new onset diabetes post transplantation used were: 1) determination of glycemia ≥ 200 mg / dl; 2) fasting glycemia ≥ 126 mg / dl, 3), blood glucose ≥ 200 mg / dL at two hours of oral glucose load test of 75 g glucose and 4) requirement for oral hypoglycemic agents or insulin to maintain normoglycemia. All criteria were evaluated  after discharge. All patients were followed from the day of transplant for up to 365 days, or until diagnosis of new onset diabetes post transplantation, death or re-transplantation, whichever occurred first. The incidence rate of new onset diabetes after transplantation was estimated. Associated factors to new onset diabetes after transplantation were assessed using  a regression model for the compeeting events death and liver re-transplantation. (Fine and Gray)

Results
We included 110 patients: median of age 60 (RIC 48-64) years; 63 (57%) were men. A total of 99 (90%) had diagnosis of cirrhosis. The cause of cirrhosis was hepatitis C in 39 (35%) patients, of whom 13 (33%) presented hepatitis C recurrence after transplantation. During follow-up, 14 patients died, 1 was re-transplanted and 32 (29 %) developed new onset diabetes post transplantation. Seventeen (53%) patients defined as transient new onset diabetes after transplantation and 13 (40.6%) as early new onset diabetes after transplantation.

The incidence Rate of new onset diabetes post transplantation was 48 x 100 person-year. The bivariate analysis showed, male sex and recurrence of hepatitis C were associated with new onset diabetes after transplantation. Hepatitis C recurrence was the only variable independently associated with new onset diabetes after transplantation (sHR 2.67, 95% CI 1.13-6.30, p = 0.025), adjusted for sex, liver rejection, cytomegalovirus reactivation and use of steroids for more than 6 months after liver transplantation.
 

Discussion
We found a similar incidence of new onset diabetes after liver transplantation than in others reports. The only factor associated with the development of new onset diabetes post liver transplantation was recurrence of virus c.

Conflict of Interest
I have no potential conflict of interest to disclose