Department of Hepatobiliary Surgery, Beijing Chaoyang Hospital Affiliated to Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China.
J Endocrinol Invest. 2018 Feb;41(2):211-221. doi: 10.1007/s40618-017-0721-z. Epub 2017 Jun 30.
It has been demonstrated that the prognosis of liver transplantation (LT) is significantly influenced by pretransplant factors, such as diabetes mellitus (DM). However, inconsistent observations are obtained.
We comprehensively searched PubMed, Embase and Web of Science to identify eligible cohort studies to evaluate the impact of preexisting DM on LT prognosis. Overall mortality and graft loss, as the most frequently observed parameters, were used to evaluate the outcomes of LT. Hazard ratios (HRs) with their 95% confidence intervals (CIs) were pooled to assess the effect of DM.
15,768 diabetic LT recipients and 60,176 non-diabetic LT recipients from 13 populations were included in this meta-analysis. Preexisting DM increased the risk for overall death of LT by 40% (95% CI 1.22-1.61), compared with DM-free patients. In addition, the risk for graft loss was also elevated by pretransplant DM (HR 1.28, 95% CI 1.07-1.54). Both analyses showed high heterogeneities (I = 85.2 and 93.2%, respectively) and their sources were not identified by meta-regression analyses. In terms of the additive effect of hepatitis C virus (HCV) infection on poor outcomes of diabetic LT recipients, stratified meta-analyses were conducted. It was demonstrated that HCV infection increased the risk for mortality by 73% (95% CI 1.64-1.83), relatively higher than non-HCV recipients (HR 1.32, 95% CI 1.25-1.39) and general population (HR 1.40, 95% CI 1.22-1.61).
Preexisting DM predicts worse patient and graft survivals of LT. Concomitant HCV infection would further deteriorate this unfavorable impact. Given the high heterogeneities and the insufficient evidences, more studies are still warranted to support these observations.
已有研究表明，肝移植（LT）的预后受移植前因素的显著影响，如糖尿病（DM）。然而，观察结果并不一致。
我们全面检索了 PubMed、Embase 和 Web of Science，以确定评估预先存在的 DM 对 LT 预后影响的合格队列研究。总体死亡率和移植物丢失作为最常观察的参数，用于评估 LT 的结果。使用风险比（HR）及其 95％置信区间（CI）来评估 DM 的影响。
这项荟萃分析纳入了来自 13 个人群的 15768 例糖尿病 LT 受者和 60176 例非糖尿病 LT 受者。与无 DM 患者相比，预先存在的 DM 使 LT 患者的总体死亡风险增加了 40％（95％CI 1.22-1.61）。此外，移植前 DM 也增加了移植物丢失的风险（HR 1.28，95％CI 1.07-1.54）。这两项分析均显示存在高度异质性（分别为 85.2％和 93.2％），但无法通过荟萃回归分析确定其来源。关于丙型肝炎病毒（HCV）感染对糖尿病 LT 受者不良结局的附加影响，进行了分层荟萃分析。结果表明，HCV 感染使死亡率增加了 73％（95％CI 1.64-1.83），相对高于非 HCV 受者（HR 1.32，95％CI 1.25-1.39）和一般人群（HR 1.40，95％CI 1.22-1.61）。
预先存在的 DM 预测 LT 的患者和移植物存活率较差。同时存在 HCV 感染会进一步恶化这种不利影响。鉴于高度异质性和证据不足，仍需要更多的研究来支持这些观察结果。
