Tang Saxiao, Mei Shengmin, Shen Shichao, Wang Li, Wu Yue, Xiang Jie, Li Zhiwei
Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Liver Transplant Center, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Ann Transplant. 2025 Sep 2;30:e949062. doi: 10.12659/AOT.949062.
BACKGROUND New-onset diabetes after transplantation (NODAT) is a common complication following liver transplantation, with serious patient and graft outcomes. The recent advances in transplant techniques and management have improved patient survival and consequently led to an increase in NODAT. Therefore, this study aimed to evaluate the current trends in the incidence, risk factors, and impact of NODAT on outcomes using a large national-level database. MATERIAL AND METHODS Adult liver transplant recipients who underwent the procedure between 2013 and 2022 were identified from the Scientific Registry of Transplant Recipients database. NODAT was defined as diabetes newly diagnosed after transplantation. Logistic regression was used to identify risk factors. Kaplan-Meier analysis and Cox regression analysis were performed to assess the impact of NODAT on patient and graft survival. RESULTS Among 39 828 recipients who met the study criteria, 2973 (7.5%) developed NODAT. Independent risk factors for NODAT included recipient age >50 years, male sex, BMI >25 kg/m², cytomegalovirus infection, steroid and tacrolimus use at discharge, deceased donor, longer warm ischemia time, and donor diabetes history. NODAT was associated with decreased graft survival (HR=1.28, 95% CI=1.10-1.48, P<0.001) but not patient survival. Moreover, the recipients who developed NODAT had higher rates of graft failure due to vascular thrombosis. CONCLUSIONS NODAT affects 7.5% of liver transplant recipients and is associated with decreased graft survival. Identifying high-risk patients and optimizing modifiable risk factors may help improve outcomes.
移植后新发糖尿病（NODAT）是肝移植后常见的并发症，会导致严重的患者和移植物预后。移植技术和管理方面的最新进展提高了患者生存率，从而导致NODAT发病率上升。因此，本研究旨在利用一个大型国家级数据库评估NODAT的发病率、危险因素及其对预后的影响的当前趋势。
从移植受者科学登记数据库中识别出2013年至2022年间接受肝移植手术的成年受者。NODAT被定义为移植后新诊断的糖尿病。采用逻辑回归分析确定危险因素。进行Kaplan-Meier分析和Cox回归分析以评估NODAT对患者和移植物存活的影响。
在39828名符合研究标准的受者中，2973名（7.5%）发生了NODAT。NODAT的独立危险因素包括受者年龄>50岁、男性、BMI>25kg/m²、巨细胞病毒感染、出院时使用类固醇和他克莫司、脑死亡供体、较长的热缺血时间以及供体糖尿病史。NODAT与移植物存活率降低相关（HR=1.28，95%CI=1.10-1.48，P<0.001），但与患者存活率无关。此外，发生NODAT的受者因血管血栓形成导致移植物失败的发生率更高。
NODAT影响7.5%的肝移植受者，并与移植物存活率降低相关。识别高危患者并优化可改变的危险因素可能有助于改善预后。
