Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury

Hermien Hartog; Christine J. H. May; Chris Corbett; Angela Phillips; Jeremy W. Tomlinson; Hynek Mergental; John Isaac; Simon Bramhall; Darius F. Mirza; Paolo Muiesan; M. Thamara P. R. Perera

doi:10.1111/liv.12706

Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury

Hermien Hartog, Christine J. H. May, Chris Corbett, Angela Phillips, Jeremy W. Tomlinson, Hynek Mergental, John Isaac, Simon Bramhall, Darius F. Mirza, Paolo Muiesan, M. Thamara P. R. Perera^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background & Aims: We studied new-onset diabetes after transplantation (NODAT) in liver transplantation with grafts donated after brain death (DBD) or circulatory death (DCD), focusing on the early post-transplant period.

Methods: A total of 430 non-diabetic primary liver transplant recipients [DCD, n=90 (21%)] were followed up for 30months (range 5-69). NODAT was defined as the composite endpoint of one of following: (i) Two non-fasting plasma glucose levels > 11.1mmol/L30days apart, (ii) oral hypoglycaemic drugs 30days consecutively (iii) insulin therapy 30days and (iv) HbA1c 48mmol/L. Resolution of NODAT was defined as cessation of treatment or hyperglycaemia.

Results: Total of 81/430 (19%) patients developed NODAT. Incidence and resolution of NODAT over time showed significantly different patterns between DCD and DBD liver graft recipients; early occurrence, high peak incidence and early resolution were seen in DCD. In multivariate logistic regression including age, ethnicity, HCV, tacrolimus level and pulsed steroids, only DCD was independently associated with NODAT at day 15 post-transplant (OR 6.5, 95% CI 2.3-18.4, P

Conclusion: Early peak of NODAT in DCD graft recipients is a novel finding, occurring independently from known risk factors. Donor warm ischaemia and impact on insulin sensitivity should be further studied and could perhaps be associated with graft function.

Original language	English
Pages (from-to)	1739-1747
Number of pages	9
Journal	Liver International
Volume	35
Issue number	6
DOIs	https://doi.org/10.1111/liv.12706
Publication status	Published - Jun-2015
Externally published	Yes

Keywords

diabetes mellitus
donation after circulatory death
hyperglycaemia
liver transplantation
NODAT
INTERNATIONAL CONSENSUS GUIDELINES
RISK-FACTORS
KIDNEY-TRANSPLANTATION
INSULIN-RESISTANCE
MELLITUS
RECIPIENTS
GLUCOSE
DEATH
METAANALYSIS
REPERFUSION

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Early occurrence of new-onset diabetes after transplantationFinal publisher's version, 1.27 MBLicence: Taverne

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@article{019604c8d7724a82aa1161f7d0b4c1dd,

title = "Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury",

abstract = "Background & Aims: We studied new-onset diabetes after transplantation (NODAT) in liver transplantation with grafts donated after brain death (DBD) or circulatory death (DCD), focusing on the early post-transplant period.Methods: A total of 430 non-diabetic primary liver transplant recipients [DCD, n=90 (21%)] were followed up for 30months (range 5-69). NODAT was defined as the composite endpoint of one of following: (i) Two non-fasting plasma glucose levels > 11.1mmol/L30days apart, (ii) oral hypoglycaemic drugs 30days consecutively (iii) insulin therapy 30days and (iv) HbA1c 48mmol/L. Resolution of NODAT was defined as cessation of treatment or hyperglycaemia.Results: Total of 81/430 (19%) patients developed NODAT. Incidence and resolution of NODAT over time showed significantly different patterns between DCD and DBD liver graft recipients; early occurrence, high peak incidence and early resolution were seen in DCD. In multivariate logistic regression including age, ethnicity, HCV, tacrolimus level and pulsed steroids, only DCD was independently associated with NODAT at day 15 post-transplant (OR 6.5, 95% CI 2.3-18.4, PConclusion: Early peak of NODAT in DCD graft recipients is a novel finding, occurring independently from known risk factors. Donor warm ischaemia and impact on insulin sensitivity should be further studied and could perhaps be associated with graft function.",

keywords = "diabetes mellitus, donation after circulatory death, hyperglycaemia, liver transplantation, NODAT, INTERNATIONAL CONSENSUS GUIDELINES, RISK-FACTORS, KIDNEY-TRANSPLANTATION, INSULIN-RESISTANCE, MELLITUS, RECIPIENTS, GLUCOSE, DEATH, METAANALYSIS, REPERFUSION",

author = "Hermien Hartog and May, {Christine J. H.} and Chris Corbett and Angela Phillips and Tomlinson, {Jeremy W.} and Hynek Mergental and John Isaac and Simon Bramhall and Mirza, {Darius F.} and Paolo Muiesan and Perera, {M. Thamara P. R.}",

year = "2015",

month = jun,

doi = "10.1111/liv.12706",

language = "English",

volume = "35",

pages = "1739--1747",

journal = "Liver International",

issn = "1478-3223",

publisher = "Wiley",

number = "6",

}

TY - JOUR

T1 - Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury

AU - Hartog, Hermien

AU - May, Christine J. H.

AU - Corbett, Chris

AU - Phillips, Angela

AU - Tomlinson, Jeremy W.

AU - Mergental, Hynek

AU - Isaac, John

AU - Bramhall, Simon

AU - Mirza, Darius F.

AU - Muiesan, Paolo

AU - Perera, M. Thamara P. R.

PY - 2015/6

Y1 - 2015/6

N2 - Background & Aims: We studied new-onset diabetes after transplantation (NODAT) in liver transplantation with grafts donated after brain death (DBD) or circulatory death (DCD), focusing on the early post-transplant period.Methods: A total of 430 non-diabetic primary liver transplant recipients [DCD, n=90 (21%)] were followed up for 30months (range 5-69). NODAT was defined as the composite endpoint of one of following: (i) Two non-fasting plasma glucose levels > 11.1mmol/L30days apart, (ii) oral hypoglycaemic drugs 30days consecutively (iii) insulin therapy 30days and (iv) HbA1c 48mmol/L. Resolution of NODAT was defined as cessation of treatment or hyperglycaemia.Results: Total of 81/430 (19%) patients developed NODAT. Incidence and resolution of NODAT over time showed significantly different patterns between DCD and DBD liver graft recipients; early occurrence, high peak incidence and early resolution were seen in DCD. In multivariate logistic regression including age, ethnicity, HCV, tacrolimus level and pulsed steroids, only DCD was independently associated with NODAT at day 15 post-transplant (OR 6.5, 95% CI 2.3-18.4, PConclusion: Early peak of NODAT in DCD graft recipients is a novel finding, occurring independently from known risk factors. Donor warm ischaemia and impact on insulin sensitivity should be further studied and could perhaps be associated with graft function.

AB - Background & Aims: We studied new-onset diabetes after transplantation (NODAT) in liver transplantation with grafts donated after brain death (DBD) or circulatory death (DCD), focusing on the early post-transplant period.Methods: A total of 430 non-diabetic primary liver transplant recipients [DCD, n=90 (21%)] were followed up for 30months (range 5-69). NODAT was defined as the composite endpoint of one of following: (i) Two non-fasting plasma glucose levels > 11.1mmol/L30days apart, (ii) oral hypoglycaemic drugs 30days consecutively (iii) insulin therapy 30days and (iv) HbA1c 48mmol/L. Resolution of NODAT was defined as cessation of treatment or hyperglycaemia.Results: Total of 81/430 (19%) patients developed NODAT. Incidence and resolution of NODAT over time showed significantly different patterns between DCD and DBD liver graft recipients; early occurrence, high peak incidence and early resolution were seen in DCD. In multivariate logistic regression including age, ethnicity, HCV, tacrolimus level and pulsed steroids, only DCD was independently associated with NODAT at day 15 post-transplant (OR 6.5, 95% CI 2.3-18.4, PConclusion: Early peak of NODAT in DCD graft recipients is a novel finding, occurring independently from known risk factors. Donor warm ischaemia and impact on insulin sensitivity should be further studied and could perhaps be associated with graft function.

KW - diabetes mellitus

KW - donation after circulatory death

KW - hyperglycaemia

KW - liver transplantation

KW - NODAT

KW - INTERNATIONAL CONSENSUS GUIDELINES

KW - RISK-FACTORS

KW - KIDNEY-TRANSPLANTATION

KW - INSULIN-RESISTANCE

KW - MELLITUS

KW - RECIPIENTS

KW - GLUCOSE

KW - DEATH

KW - METAANALYSIS

KW - REPERFUSION

U2 - 10.1111/liv.12706

DO - 10.1111/liv.12706

M3 - Article

SN - 1478-3223

VL - 35

SP - 1739

EP - 1747

JO - Liver International

JF - Liver International

IS - 6

ER -

Early occurrence of new-onset diabetes after transplantation is related to type of liver graft and warm ischaemic injury

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Keywords

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