Lv Chaoyang, Zhang Yao, Chen Xianying, Huang Xiaowu, Xue Mengjuan, Sun Qiman, Wang Ting, Liang Jing, He Shunmei, Gao Jian, Zhou Jian, Yu Mingxiang, Fan Jia, Gao Xin
Department of Endocrinology and Metabolism, Zhongshan Hospital, Shanghai, China.
Department of Endocrinology and Metabolism, Hainan Provincial Nong Ken Hospital, Hainan, China.
J Diabetes. 2015 Nov;7(6):881-90. doi: 10.1111/1753-0407.12275. Epub 2015 Mar 24.
The aim of the present study was to investigate the incidence and risk factors of new-onset diabetes after transplantation (NODAT) in liver transplant recipients and the influence of NODAT on complications and long-term patient survival.
We examined 438 patients who underwent liver transplantation between April 2001 and December 2008 and were not diabetic before transplantation.
The mean (± SD) follow-up duration was 2.46 ± 1.62 years. The incidence of NODAT 3, 6, 9, 12, 36, and 60 months after transplantation was 44.24%, 25.59%, 23.08%, 25.17%, 17.86%, and 18.18%, respectively. Multifactor analysis indicated that preoperative fasting plasma glucose (FPG) levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an interleukin-2 receptor (IL-2R) antagonist reduced the risk of NODAT. Compared with the no NODAT group (N-NODAT), the NODAT group had a higher rate of sepsis and chronic renal insufficiency. Mean survival was significantly longer in the N-NODAT than NODAT group. Cox regression analysis showed that pre- and/or postoperative FPG levels, tumor recurrence or metastasis, and renal insufficiency after liver transplantation were independent risk factors of mortality. Pulmonary infection or multisystem failure were specific causes of death in the NODAT group, whereas patients in both groups died primarily from tumor relapse or metastasis.
Preoperative FPG levels and donor liver steatosis were independent risk factors for NODAT, whereas administration of an IL-2R antagonist reduced the risk of NODAT. Patients with NODAT had reduced survival and an increased incidence of sepsis and chronic renal insufficiency. Significant causes of death in the NODAT group were pulmonary infection and multisystem failure.
本研究旨在调查肝移植受者移植后新发糖尿病（NODAT）的发生率和危险因素，以及NODAT对并发症和患者长期生存的影响。
我们检查了2001年4月至2008年12月期间接受肝移植且移植前无糖尿病的438例患者。
平均（±标准差）随访时间为2.46±1.62年。移植后3、6、9、12、36和60个月时NODAT的发生率分别为44.24%、25.59%、23.08%、25.17%、17.86%和18.18%。多因素分析表明，术前空腹血糖（FPG）水平和供体肝脂肪变性是NODAT的独立危险因素，而使用白细胞介素-2受体（IL-2R）拮抗剂可降低NODAT的风险。与无NODAT组（N-NODAT）相比，NODAT组的败血症和慢性肾功能不全发生率更高。N-NODAT组的平均生存期明显长于NODAT组。Cox回归分析表明，肝移植术前和/或术后FPG水平、肿瘤复发或转移以及肾功能不全是死亡的独立危险因素。肺部感染或多系统衰竭是NODAT组的特定死亡原因，而两组患者主要死于肿瘤复发或转移。
术前FPG水平和供体肝脂肪变性是NODAT的独立危险因素，而使用IL-2R拮抗剂可降低NODAT的风险。NODAT患者的生存率降低，败血症和慢性肾功能不全的发生率增加。NODAT组死亡的重要原因是肺部感染和多系统衰竭。
