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- Title
Diabetes mellitus increases the risk of mortality following liver transplantation independent of MELD score.
- Authors
Samuelson, Andrew L; Lee, Maximilian; Kamal, Ahmad; Keeffe, Emmet B; Ahmed, Aijaz
- Abstract
<bold>Background: </bold>Patients with diabetes mellitus overall experience worse health outcomes than non-diabetics, but whether this is true among recipients of liver transplantation still remains unclear. The aim of this study was to compare the mortality of diabetic and non-diabetic patients following liver transplantation.<bold>Methods: </bold>We conducted a retrospective analysis of 530 adult patients undergoing liver transplantation at Stanford University Medical Center from February 1995 to July 2006. Information on diabetes mellitus was available for 431 patients; 96 patients who had acute liver failure (n = 17), combined liver and kidney transplantation (n = 28), or died prior to discharge (n = 51) were excluded from analysis.<bold>Results: </bold>Over a mean follow-up of 4.5 years, survival was 81% in the diabetic group and 94% among controls (p = <0.0001). After controlling for age (mean +/- SD: 54.4 +/- 7.6 in diabetics, 50.1 +/- 9.6 in controls), body mass index (28.6 +/- 6.6 in diabetics, 27.1 +/- 5.4 in controls), presence of hepatitis C, and MELD score (17 +/- 9.6 in diabetics, 19 +/- 10.2 in controls), diabetes mellitus remained a significant predictor of death (HR 3.11, p = 0.01).<bold>Conclusions: </bold>Diabetes mellitus is an independent risk factor for mortality following liver transplantation. Further investigation of this relationship should focus on the impact of more intensive pre- and post-liver transplantation glucose control, cardiovascular risk factor reduction, and the effects of accelerated atherosclerosis in the setting of immune suppression.
- Subjects
DIAGNOSIS of diabetes; AGE distribution; COMPARATIVE studies; CAUSES of death; DIABETES; LIVER failure; LIVER transplantation; LONGITUDINAL method; RESEARCH methodology; MEDICAL cooperation; MULTIVARIATE analysis; PROBABILITY theory; RESEARCH; RISK assessment; SEX distribution; SURVIVAL analysis (Biometry); LOGISTIC regression analysis; EVALUATION research; RETROSPECTIVE studies; SEVERITY of illness index; CASE-control method; KAPLAN-Meier estimator
- Publication
Digestive Diseases & Sciences, 2010, Vol 55, Issue 7, p2089
- ISSN
0163-2116
- Publication type
journal article
- DOI
10.1007/s10620-010-1267-5