Poor outcome in patients with diabetes mellitus undergoing: Liver transplantation.

Background Relatively few studies have examined the influence of pretranspl ant diabetes on survival after an orthotopic liver transplant (OLT), and th ose published to date show only minor increases in infection rates among di abetics and no increase in mortality. Methods. me examined the effect of diabetes mellitus on survival after OLT. 1005 adults underwent OLT between 1982 and May 1997. Seventy-eight patient s with pretransplant diabetes mellitus (7.8% of all OLT, 38 insulin treated , 25 tablet treated, 15 diet controlled) were identified and compared with controls matched for age, sex, and date of first transplant and also with a ll nondiabetic adult liver recipients undergoing OLT during the same period . Results. In patients undergoing OLT survival was worse in diabetics than in the comparison group (P=0.002) and vs. all adult nondiabetics undergoing ( n=927) (P=0.004); in diabetics with alcoholic liver disease (ALD) vs, all n ondiabetics with alcoholic liver disease (P=<0,0001); and in insulin-treate d compared with non-insulin-treated diabetics (P=0.05). Multivariate analys is showed type of diabetes (P=0,001) and ALD (P=0.024) to be the most signi ficant independent variables adversely affecting survival. Survival in diab etics undergoing OLT could be further stratified according to whether diabe tics were insulin treated. Conclusions, Poorer outcome in the diabetics undergoing OLT, particularly i n those with ALD, suggests the need for a more detailed pre OLT assessment of these patients, particularly those with insulin and tablet controlled di abetes.