University of Toronto, Toronto, ON, Canada.
Multi Organ Transplant Program, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.
Clin Transplant. 2021 Jul;35(7):e14340. doi: 10.1111/ctr.14340. Epub 2021 Jun 13.
Post-transplant diabetes mellitus (PTDM) compromises long-term survival in liver transplant (LT) recipients. The aim of this study was to determine incidence of PTDM after LT and risk factors associated with it. A literature search was conducted, and prospective studies that reported on the incidence of PTDM in LT adult patients on tacrolimus, sirolimus, or cyclosporine were included. We performed random effects meta-analyses for the incidence of PTDM stratified by immunosuppressant and time period. Of 9817 articles identified, 26 studies were included in the qualitative analysis and 21 studies were eligible for the quantitative analysis representing 79 559 LT recipients in 32 separate treatment arms. The proportion of patients who developed PTDM by two-three years was 0.15 (95% CI: 0.10-0.24) for cyclosporine, 0.23 (95% CI: 0.14-0.36) for tacrolimus, and 0.27 (95% CI: 0.23-0.30) for sirolimus. CONCLUSION: Our results showed that sirolimus-based immunosuppression was associated with a higher incidence of PTDM than tacrolimus or cyclosporine at two-three years. However, there were only two studies that compared all three drugs which is a limitation of the study and requires more studies with patients on sirolimus. Recipient factors increasing the risk of PTDM are older age, male sex, and high BMI.
移植后糖尿病（PTDM）会影响肝移植（LT）受者的长期生存。本研究旨在确定 LT 后 PTDM 的发生率及其相关危险因素。进行了文献检索，并纳入了报告在使用他克莫司、西罗莫司或环孢素的 LT 成年患者中 PTDM 发生率的前瞻性研究。我们对免疫抑制剂和时间段分层的 PTDM 发生率进行了随机效应荟萃分析。在确定的 9817 篇文章中，26 项研究纳入了定性分析，21 项研究符合定量分析的条件，涉及 32 个单独治疗组的 79559 名 LT 受者。在 2-3 年内发生 PTDM 的患者比例分别为：环孢素为 0.15（95%CI：0.10-0.24），他克莫司为 0.23（95%CI：0.14-0.36），西罗莫司为 0.27（95%CI：0.23-0.30）。结论：我们的结果表明，在 2-3 年内，与他克莫司或环孢素相比，西罗莫司免疫抑制与 PTDM 的发生率更高。然而，只有两项研究比较了所有三种药物，这是该研究的局限性，需要更多使用西罗莫司的患者进行研究。增加 PTDM 风险的受者因素包括年龄较大、男性和高 BMI。
