Outcome of liver transplantation in patients with diabetes mellitus: A case-control study

The influence of preexisting diabetes mellitus (DM) on outcome after orthot opic liver transplantation (OLT) has not been well defined. The objective o f our study was to compare the morbidity and mortality after OLT in 57 pati ents with preexisting DM (3 type 1, 54 type II) with 114 age-, sex-, and ra ce-matched patients without DM (case controls). The demographics were simil ar in both groups. Pretransplantation serum creatinine was significantly hi gher in the diabetic group compared with case controls. The incidence of th e following complications was significantly higher in the diabetic group af ter OLT: cardiovascular (61.4% vs. 21.9%, P < .001), major (54.4% vs. 29.8% , P = .002) and minor infections (29.8% vs. 7.9%, P < .0001), renal (59.7% vs. 20.2%, P < .001), ophthalmologic (10.5% vs. 0.9%, P = .01), respiratory (24.6% vs. 7.0%, P = .001), neurologic (31.6% vs. 7.0%, P < .001), hematol ogic (19.3% vss 2.6%, P = .001), musculoskeletal (24.6% vs. 5.3%, P = .001) , and malignancy (22.8% vs. 10.5%, P = .03). The duration of hospital stay, cost of hospitalization, retransplantation, and overall graft survival wer e similar. Acute rejection was seen in 50.9% of diabetics compared with 25. 4% in controls (P = .0009). One-year (87% vs. 77%) and 2-year (81.6% vs. 70 .1%) patient survival was similar, but 5-year survival was lower in the DM group (34.4% vs. 67.7%, P = .002). In conclusion, preexisting diabetes is a ssociated with a significant post-OLT morbidity and mortality, and our obse rvations suggest that patients with DM warrant more rigorous pre- and post- OLT evaluation.