Abe T, Onoe T, Tahara H, Tashiro H, Ishiyama K, Ide K, Ohira M, Ohdan H
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Institute for Clinical Research, National Hospital Organization, Kure Medical Center/Chugoku Cancer Center, Kure, Japan.
Transplant Proc. 2014 Apr;46(3):865-9. doi: 10.1016/j.transproceed.2013.12.027.
New-onset diabetes mellitus (NODM) has a negative impact on graft and patient survivals. Hepatitis C virus (HCV) infection, high body mass index, increased donor and recipient ages, and calcineurin inhibitor (CNI) type have been identified as risk factors for the development of NODM. We aimed to elucidate the risk factors for the development of NODM and those for progressive glucose intolerance in adult living-donor liver transplant (LDLT) recipients.
We collected data from 188 primary liver transplant recipients (age > 16 years) who underwent LDLT from June 1991 to December 2011 at Hiroshima University Hospital. Risk factors for NODM and progressive impairment of glucose metabolism in pre-transplantation diabetes mellitus (DM) recipients were examined.
Pre-transplantation DM was diagnosed in 32 recipients (19.3%). The overall incidence of NODM was 6.0% (8/134 recipients). Multivariate analysis revealed that old recipient age (≥55 years) is a unique predictive risk factor for developing NODM. The incident of pre-transplantation DM was significantly higher in recipients with HCV infection than in those without HCV. A high pre-transplantation triglyceride level was an independent risk factor for progressive impairment of glucose tolerance among 32 LDLT recipients with pre-transplantation DM. All of the NODM patients were being treated with tacrolimus at the time of diagnosis. Switching the CNI from tacrolimus to cyclosporine allowed one-half of the patients (4/8) to withdraw from insulin-dependent therapy. NODM and post-transplantation glucose intolerance had no negative impact on patient and graft outcomes.
Older age of the recipient (≥55 years) was a significant risk factor for NODM. Hypertriglyceridemia in the recipients with DM is an independent risk factor for post-transplantation progressive impairment of glucose metabolism. NODM had no negative impact on outcomes in the LDLT recipients.
新发糖尿病（NODM）对移植物和患者的生存有负面影响。丙型肝炎病毒（HCV）感染、高体重指数、供体和受体年龄增加以及钙调神经磷酸酶抑制剂（CNI）类型已被确定为NODM发生的危险因素。我们旨在阐明成人活体肝移植（LDLT）受者中NODM发生的危险因素以及进展性葡萄糖不耐受的危险因素。
我们收集了1991年6月至2011年12月在广岛大学医院接受LDLT的188例原发性肝移植受者（年龄>16岁）的数据。研究了移植前糖尿病（DM）受者中NODM和葡萄糖代谢进行性损害的危险因素。
32例受者（19.3%）被诊断为移植前DM。NODM的总体发生率为6.0%（134例受者中的8例）。多变量分析显示，受体年龄较大（≥55岁）是发生NODM的唯一预测危险因素。HCV感染的受者移植前DM的发生率显著高于未感染HCV的受者。移植前高甘油三酯水平是32例移植前DM的LDLT受者中葡萄糖耐量进行性损害的独立危险因素。所有NODM患者在诊断时均接受他克莫司治疗。将CNI从他克莫司换为环孢素使一半患者（4/8）退出胰岛素依赖治疗。NODM和移植后葡萄糖不耐受对患者和移植物结局没有负面影响。
受体年龄较大（≥55岁）是NODM的重要危险因素。DM受者的高甘油三酯血症是移植后葡萄糖代谢进行性损害的独立危险因素。NODM对LDLT受者的结局没有负面影响。
