Prevalence of diabetes mellitus in patients with end-stage liver cirrhosisdue to hepatitis C, alcohol, or cholestatic disease

Background/Aims: The aims were to study: 1) the prevalence of diabetes mell itus in patients with endstage liver cirrhosis due to hepatitis C, alcohol, or cholestatic liver disease, 2) viral and host immunogenetic factors that may predispose to diabetes, and 3) liver transplantation outcome in patien ts with or without diabetes. Methods: Fasting blood glucose values of patients who underwent liver trans plantation because of hepatitis C-related cirrhosis (73 patients) were comp ared with those of patients with cirrhosis due to cholestatic (78 patients) or alcoholic liver disease (53 patients) and to a general population. Data on diabetes prevalence in a population without liver cirrhosis was based o n the prevalence of diabetes in Olmsted County, Minnesota, residents. HLA w as determined using serologic assays. Hepatitis C virus genotypes,were dete rmined with polymerase chain reaction amplification and direct sequencing. Hepatitis G RNA was detected with polymerase chain reaction. Liver transpla ntation outcome in patients with or without diabetes was determined with re jection, retransplantation, or death at 1 year after transplantation as end points. Results: Of 64 patients with hepatitis C alone, 16 (25%) had diabetes befor e transplantation compared with 1 of 78 (1.3%) with cholestatic liver disea se (p = 0.0001) and 10 of 53 (19%) with alcoholic liver disease (p = 0.36). Nine patients had hepatitis C plus cholestatic liver disease; one of these (11%) had diabetes. The prevalence of diabetes in patients with cholestati c liver cirrhosis was not different from that of the general population. Th e frequency of hepatitis G virus coinfection, HLA-DR3, or HLA-DR4 in hepati tis C and diabetes was not different from that of hepatitis C alone. The di stribution of hepatitis C virus genotype was similar in those with and thos e without diabetes. Diabetes was not associated with increased risk of reje ction, retransplantation, or death at 1 year after transplantation, and had no impact on overall survival after transplantation. Conclusions: 1) The risk of diabetes is not increased in patients with live r cirrhosis due to cholestatic liver disease but is in patients with liver cirrhosis due to hepatitis C or alcoholic liver disease; 2) cofactors (age, sex, body mass index, hepatitis G virus coinfection, hepatitis C virus gen otype, or HLA-DR3/DR4) did not explain the increased risk of diabetes in pa tients with hepatitis C; 3) diabetes before liver transplantation did not c hange the outcome at 1 year after transplantation or survival.