Department of Nephrology, Ghent University Hospital, Ghent, Belgium.
Liver Transpl. 2010 Nov;16(11):1278-87. doi: 10.1002/lt.22146.
New-onset diabetes after transplantation (NODAT) is a frequent complication after liver transplantation and has a negative impact on both patient and graft survival. In analogy with the previous finding of an association between posttransplant hypomagnesemia and NODAT in renal transplant recipients, the relation between both pretransplant and posttransplant hypomagnesemia and NODAT was studied in liver transplant recipients (LTRs). One hundred sixty-nine adult LTRs (>18 years old) without diabetes who underwent transplantation between 2004 and 2009 were studied (mean age = 52.11 ± 12.6 years, proportion of LTRs who were male = 67.5%, body mass index = 25.5 ± 4.4 kg/m², proportion receiving tacrolimus = 90.0%). NODAT was defined according to the American Diabetes Association criteria. The association of NODAT with both pretransplant and posttransplant serum magnesium (Mg) was examined. Overall, 52 of 169 patients (30.8%) developed NODAT, and 57.7% of these (30 patients) were treated with antidiabetic drugs. Both pretransplant Mg levels and Mg levels in the first month after transplantation were lower in patients developing NODAT (P = 0.008 and P = 0.001, respectively). A multivariate regression model (adjusted for weight, pretransplant glucose levels, hyperglycemia in the first week after transplantation, gender, hepatitis C, and corticosteroid dosing) demonstrated both pretransplant Mg levels (hazard ratio = 0.844 per 0.1 mg/dL increase, 95% confidence interval = 0.764-0.932, P = 0.001) and posttransplant Mg levels (hazard ratio = 0.659, 95% confidence interval = 0.518-0.838, P = 0.001) to be independent predictors of NODAT together with age, biopsy-proven acute rejection, and cytomegalovirus (CMV) infection in the first year after transplantation. In conclusion, pretransplant hypomagnesemia and early posttransplant hypomagnesemia are independent predictors of new-onset diabetes after liver transplantation. Other risk factors are age, biopsy-proven acute rejection, and CMV infection.
移植后新发糖尿病（NODAT）是肝移植后的常见并发症，对患者和移植物的存活均有负面影响。与先前在肾移植受者中发现的移植后低镁血症与 NODAT 之间存在关联的研究类似，本研究旨在探讨肝移植受者（LTR）中移植前和移植后低镁血症与 NODAT 之间的关系。研究纳入了 2004 年至 2009 年间接受移植的 169 例无糖尿病的成年 LTR（>18 岁）（平均年龄=52.11±12.6 岁，LTR 中男性比例=67.5%，体重指数=25.5±4.4kg/m²，接受他克莫司治疗的比例=90.0%）。根据美国糖尿病协会的标准定义 NODAT。研究了 NODAT 与移植前和移植后血清镁（Mg）之间的关系。总体而言，169 例患者中有 52 例（30.8%）发生了 NODAT，其中 57.7%（30 例）接受了降糖药物治疗。发生 NODAT 的患者移植前和移植后 1 个月的 Mg 水平均较低（P=0.008 和 P=0.001）。多变量回归模型（调整体重、移植前血糖水平、移植后第一周高血糖、性别、丙型肝炎和皮质类固醇剂量）显示，移植前 Mg 水平（每增加 0.1mg/dL 的危险比=0.844，95%置信区间=0.764-0.932，P=0.001）和移植后 Mg 水平（危险比=0.659，95%置信区间=0.518-0.838，P=0.001）与年龄、经活检证实的急性排斥反应和移植后第一年的巨细胞病毒（CMV）感染一起是 NODAT 的独立预测因素。结论：移植前低镁血症和早期移植后低镁血症是肝移植后新发糖尿病的独立预测因素。其他危险因素包括年龄、经活检证实的急性排斥反应和 CMV 感染。
