DIABETES-MELLITUS AFTER LIVER-TRANSPLANTATION - PREVALENCE AND PREDICTIVE FACTORS

Aims/Methods: To investigate the prevalence and risk factors for the d evelopment of diabetes mellitus after orthotopic liver transplantation , we reviewed 27 variables (including previous history of diabetes mel litus, data related to pre-transplant liver disease, and postoperative events) in 102 patients who survived longer than 1 year after orthoto pic liver transplantation. Results: Fourteen patients had diabetes mel litus prior to liver transplantation and all but one were alive 2 and 3 years after transplantation, with all survivors continuing to have d iabetes mellitus 1, 2 and 3 years after transplantation. Among the 88 patients wihout pre-transplant diabetes mellitus, the prevalence of po st-transplant diabetes mellitus was 27% at 1 year, 9% at 2 years and 7 % at 3 years, probably related to a significant reduction in the daily prednisone dose (13+/-4 mg at 1 year, 7+/-6 mg at 2 years and 2+/-4 m g at 3 years, p<0.001). Patients with post-transplant diabetes mellitu s 1 year after transplantation had a higher number of rejection episod es during the first postoperative year than those without post-transpl ant diabetes mellitus (1.5+/-1.1 vs 1.1+/-0.7, p<0.05) and also had hi gher, but not statistically significant, cumulative steroid dose and b lood cyclosporine levels, Mortality of patients with post-transplant d iabetes mellitus was significantly higher during the second postoperat ive year in comparison with patients without post-transplant diabetes mellitus: 4/24 vs 2/64 (17% vs 3%; p<0.05). Conclusions: fiver transpl antation does not significantly modify pre-transplant diabetes mellitu s, Diabetes mellitus frequently develops de novo after liver transplan tation, although this complication is usually transient and probably r elated to immunosuppressive drug administration. The prognosis of pati ents with post-transplant diabetes mellitus is worse than that of thos e without this complication.