New-onset diabetes mellitus after liver transplantation in the patients with acute liver failure

International Journal of Diabetes in Developing Countries (2021)Cite this article

Abstract

Background

To detect the frequency and possible risk factors of new-onset diabetes after liver transplantation in the patients with acute liver failure. The frequency of new-onset diabetes after transplant (NODAT) is 5–30% in liver transplant recipients. We aimed to analyze the frequency and predictors of NODAT in the patients undergoing liver transplantation due to acute liver failure.

Methods

Adult patients undergoing liver transplantation due to acute liver failure were analyzed retrospectively. The patients with chronic liver failure or diabetes were excluded. We measured pretransplant random blood glucose and posttransplant fasting blood glucose. NODAT was diagnosed according to principally 1st month fasting blood glucose (group 1 < 100, group 2 100–125, group 3 > 125 mg/dL). The participants were subgrouped according to age, gender, body mass index, etiology, antiviral medication, thyroid function, pretransplant random blood glucose, donor type, immunosuppressive drug, common infection, and surgical complication.

Results

Mean age of total 91 patients was 33.48 (± 13.35), and 52.7% (n = 48) of them was female. The ratio of NODAT was 26.98% on the 1st month. NODAT group had a higher pretransplant random blood glucose than the others. Pretransplant hyperglycemia increased the risk of NODAT by 4.065 times (p = 0.018).

Conclusion

We showed that pretransplant hyperglycemia increased NODAT risk by 4 times, but hypoglycemia did not affect. So, pretransplant hyperglycemia should be controlled also in the patients with acute liver failure as in the patients with chronic liver failure.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

We had accepted that “the previous form” of our article could be located on a website of “https://www.researchsquare.com/article/rs-14864/v1” as a preprint, before we have submitted the article to your journal. We changed some parts of the article and title, before we have submitted our article to your journal. The authors assure that this paper has not been published before nor has been submitted for publication to another scientific journal.

The abstract of previous form of our article was accepted as an “Audio Electronic Poster” (AEP-306) with a heading of “New-Onset Diabetes Mellitus After Liver Transplantation In The Patients With Acute Liver Failure: Is There Any Effect Of Pretransplant Hypoglycemia?” in 2020 online congress of European Society of Endocrinology (e-ECE 2020).

References

  1. 1.

    Lane JT, Dagogo-Jack S. Approach to the patient with new-onset diabetes after transplant (NODAT). J Clin Endocrinol Metab. 2011;96:3289–97.

    CAS  Article  Google Scholar 

  2. 2.

    Guad RM, Taylor-Robinson AW, Wu YS, Gan SH, Zaharan NL, Basu RC, et al. Clinical and genetic risk factors for new-onset diabetes mellitus after transplantation (NODAT) in major transplant centres in Malaysia. BMC Nephrol. 2020;21:388.

    CAS  Article  Google Scholar 

  3. 3.

    Man Kim J, Hwang S, Lee KW, Lee JG, Ryu JH, Kim BW, Choi DL, You YK, Kim DS, Nah YW, Kang KJ, Cho JY, Hong G, Choi IS, Yu HC, Choi D, Kim MS; Korean Organ Transplantation Registry Study Group. New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study. Hepatobiliary Surg Nutr 2020;9:425–439.

  4. 4.

    Zielińska K, Kukulski L, Wróbel M, Przybyłowski P, Zakliczyński M, Strojek K. Prevalence and risk factors of new-onset diabetes after transplantation (NODAT). Ann Transplant. 2020;25:e926556.

    PubMed  Google Scholar 

  5. 5.

    Classification and diagnosis of diabetes: standards of medical care in diabetes—2019 American Diabetes Association. Diabetes Care 2019;42:S13-S28.

  6. 6.

    Sharif A, Hecking M, de Vries AP, Porrini E, Hornum M, Rasoul-Rockenschaub S, et al. Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions. Am J Transplant. 2014;14:1992–2000.

    CAS  Article  Google Scholar 

  7. 7.

    Gaglio PJ, Cotler SJ. Liver transplantation in adults: long-term management of transplant recipients. In: UpToDate [online]. Available at: www.UpToDateInc.com. (Accessed January 7, 2020).

  8. 8.

    Saab S, Shpaner A, Zhao Y, Brito I, Durazo F, Han S, et al. Prevalence and risk factors for diabetes mellitus in moderate term survivors of liver transplantation. Am J Transplant. 2006;6:1890–5.

    CAS  Article  Google Scholar 

  9. 9.

    Ling Q, Xu X, Xie H, Wang K, Xiang P, Zhuang R, et al. New-onset diabetes after liver transplantation: a national report from China Liver Transplant Registry. Liver Int. 2016;36:705–12.

    Article  Google Scholar 

  10. 10.

    Sook LW, Sablihan NI, Ismail S, Devaraj NK, Mooi CS. Factors associated with the level of physical activities among non-academic staffs in the Faculty of Medicine and Health Sciences of a Public University in Selangor. Malaysia Mal J Med Health Sci. 2019;15:47–55.

    Google Scholar 

  11. 11.

    Devaraj NK, Mohazmi M, Norita H. Prevalence, factors influencing and knowledge about adherence to lipid-lowering therapy among hyperlipidemia patients. Medical J Malaysia. 2017;72:157–64.

    CAS  Google Scholar 

  12. 12.

    Davern TJ, Schilsky ML, Hynan LS, Lee WM. Prevalence of diabetes mellitus is not increased in acute liver failure. Hepatology. 2004;40:499A.

    Google Scholar 

  13. 13.

    Rutherford A, Davern T, Hay JE, Murray NG, Hassanein T, Lee WM, et al. Acute Liver Failure Study Group. Influence of high body mass index on outcome in acute liver failure. Clin Gastroenterol Hepatol. 2006;4:1544–9.

    Article  Google Scholar 

  14. 14.

    Gill RQ, Sterling RK. Acute liver failure. J Clin Gastroenterol. 2001;33:191–8.

    CAS  Article  Google Scholar 

  15. 15.

    Lee WM, Stravitz RT, Larson AM. Introduction to the revised American Association for the Study of Liver Diseases Position Paper on acute liver failure 2011. Hepatology. 2012;55:965–967.

  16. 16.

    European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu; Clinical practice guidelines panel, Wendon, J; Panel members, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, Simpson KJ, Yaron I; EASL Governing Board representative, Bernardi M. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66:1047–81.

  17. 17.

    International Hypoglycaemia Study Group. Glucose concentrations of less than 3.0 mmol/L (54 mg/dL) should be reported in clinical trials: a joint position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2017;40:155–7.

  18. 18.

    Sharif A, Baboolal K. Risk factors for new-onset diabetes after kidney transplantation. Nat Rev Nephrol. 2010;6:415–23.

    Article  Google Scholar 

  19. 19.

    Oommen T, Arun CS, Kumar H, Nair V, Jayakumar RV, Sudhindran S, et al. Incidence of new-onset diabetes and posttransplant metabolic syndrome after liver transplantation - a prospective study from South India. Indian J Endocrinol Metab. 2020;24:165–9.

    CAS  Article  Google Scholar 

  20. 20.

    Pham PT, Pham PC, Lipshutz GS, Wilkinson AH. New onset diabetes mellitus after solid organ transplantation. Endocrinol Metab Clin North Am. 2007;36:873–90;vii.

  21. 21.

    Kerwin AJ, Nussbaum MS. Adjuvant nutrition management of patients with liver failure, including transplant. Surg Clin North Am. 2011;91:565–78.

    Article  Google Scholar 

  22. 22.

    Schilsky ML, Honiden S, Arnott L, Emre S. ICU management of acute liver failure. Clin Chest Med. 2009;30:71–87 viii.

    Article  Google Scholar 

  23. 23.

    Chakkera HA, Knowler WC, Devarapalli Y, Weil EJ, Heilman RL, Dueck A, et al. Relationship between inpatient hyperglycemia and insulin treatment after kidney transplantation and future new onset diabetes mellitus. Clin J Am Soc Nephrol. 2010;5:1669–75.

    CAS  Article  Google Scholar 

  24. 24.

    Caillard S, Eprinchard L, Perrin P, Braun L, Heibel F, Moreau F, et al. Incidence and risk factors of glucose metabolism disorders in kidney transplant recipients: role of systematic screening by oral glucose tolerance test. Transplantation. 2011;91:757–64.

    CAS  PubMed  Google Scholar 

  25. 25.

    Zahir N, Mousa D, Al Taweel A, Ashraf A, Fahim A, Taqi K, et al. Prospective nonrandomized study with early steroid withdrawal (day 5) postrenal transplant in low immunological risk patients: a singlecenter experience at prince sultan military medical city Riyadh. Saudi J Kidney Dis Transpl. 2019;30:1398–406.

    Article  Google Scholar 

  26. 26.

    Hur KY, Kim MS, Kim YS, Kang ES, Nam JH, Kim SH, et al. Risk factors associated with the onset and progression of posttransplantation diabetes in renal allograft recipients. Diabetes Care. 2007;30:609–15.

    Article  Google Scholar 

  27. 27.

    Roth D, Milgrom M, Esquenazi V, Fuller L, Burke G, Miller J. Posttransplant hyperglycemia. Increased incidence in cyclosporine-treated renal allograft recipients. Transplantation. 1989;47:278–81.

    CAS  Article  Google Scholar 

  28. 28.

    Wu Y, You S, Zang H, Liu H, Mao Y, Mao P, et al. Usefulness of serum thyroid-stimulation hormone (TSH) as a prognostic indicator for acute-on-chronic liver failure. Ann Hepatol. 2015;14:218–24.

    CAS  Article  Google Scholar 

  29. 29.

    Moura Neto A, Bovi TG, Righetto CM, Fiore AR, Lot LT, Perales SR, et al. Frequency of thyroid dysfunction in patients with diabetes mellitus before and after liver transplantation. Transplant Proc. 2018;50:788–91.

    CAS  Article  Google Scholar 

  30. 30.

    Anastasiou O, Sydor S, Sowa JP, Manka P, Katsounas A, Syn WK, et al. Higher thyroid-stimulating hormone, triiodothyronine and thyroxine values are associated with better outcome in acute liver failure. PLoS One. 2015;10:e0132189.

    Article  Google Scholar 

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Acknowledgements

All authors contributed to the study conception and design. Study design, material preparation, data collection, and analysis were performed by Ömercan Topaloğlu, Muhammet Cengiz, Ayşe Cengiz, Bahri Evren, Saim Yoloğlu, Sezai Yılmaz, and İbrahim Şahin. The first draft of the manuscript was written by Ömercan Topaloğlu, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Affiliations

  1. Kocaeli Derince Training and Research Hospital, Endocrinology Clinics, University of Health Sciences, Derince, Kocaeli, Turkey

    Ömercan Topaloğlu

  2. Department of Internal Medicine, Inonu University Medical Faculty, Malatya, Turkey

    Muhammet Cengiz & Ayşe Cengiz

  3. Department of Endocrinology, Inonu University Medical Faculty, Malatya, Turkey

    Bahri Evren & İbrahim Şahin

  4. Department of Biostatistics, Inonu University Medical Faculty, Malatya, Turkey

    Saim Yoloğlu

  5. Department of General Surgery, Inonu University Medical Faculty, Malatya, Turkey

    Sezai Yılmaz

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  1. Ömercan Topaloğlu
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  2. Muhammet Cengiz
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Correspondence to Ömercan Topaloğlu.

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The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Our study was designed as retrospective manner, and we performed our study in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Our study was approved by the Ethics Committee of Inonu University (Malatya Clinical Researches Ethic Committee, approval date:04 January 2017, approval number:2017/11).

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Due to the retrospective design of the study and the use of already available data, written informed consent was unavailable.

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Topaloğlu, Ö., Cengiz, M., Cengiz, A. et al. New-onset diabetes mellitus after liver transplantation in the patients with acute liver failure. Int J Diabetes Dev Ctries (2021). https://doi.org/10.1007/s13410-021-00922-y

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Keywords

  • NODAT
  • Acute liver failure
  • Liver transplant
  • Posttransplant diabetes
  • New onset diabetes
  • Diabetes mellitus