Influence of Immunosuppression and Effect of Hepatitis C Virus on New Onset of Diabetes Mellitus in Liver Transplant Recipients

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Transplantation Proceedings

Volume 40, Issue 9, November 2008, Pages 2994-2996

Liver transplantation

Influence of Immunosuppression and Effect of Hepatitis C Virus on New Onset of

Diabetes Mellitus in Liver Transplant Recipients

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B. Sánchez-Péreza, , , J.M. Aranda Narváeza, J. Santoyo Santoyoa, J.L.

Fernández-Aguilara, M.A. Suárez Muñoza, A.J. González-Sáncheza, J.A. Pérez

Dagaa, C.P. Ramírez Plazaa, J. Carrasco Camposa, C. Jiménez Mazure and R.

Becerra Ortíz

aHepatobiliary and Transplant Unit, Haya University Hospital, Málaga,

Spain

Available online 17 November 2008.

Abstract

Introduction

New-onset posttransplantation diabetes mellitus (PTDM), with an incidence of 10%

to 30%, increased graft and patient morbidity and mortality. Such causal factors

as age, obesity, therapy, immunosuppression, and hepatitis C virus (HCV)

contribute to this disease.

Objective

We sought to determine the incidence of PTDM and impaired fasting glucose (IFG)

concentration in transplant recipients to define the causal variables.

Material and Methods

The study included 127 patients. Patients with pretransplantation diabetes and

those with less than 6 months of follow-up were excluded. A descriptive

observational study to assess the association between PTDM and IFG and the

immunosuppression therapy used was performed by monitoring the potential

confounding variables of age, obesity, and HCV.

Results

During mean follow-up of 73.7 months (range, 7–120 mo), 93 patients received

cyclosporine A (CyA) and 34 received tacrolimus (Tac) therapy. Thirty patients

(23.6%) developed PTDM or IFG including 15 (16%; PTDM, six IFG, nine) in the CyA

group and 15 (PTDM, seven; IFG, eight) in the Tacrolimus group (P = .001; odds

ratio [OR], 4.1). They were homogeneous with respect to confounding variables

except for HCV (P = .01). Of the 55 patients with HCV infection, 12 developed

PTDM or IFG, including three in the CyA group and nine in the tacrolimus group

(P = .03; OR, 7.7), whereas in the 72 patients without HCV infection, the CyA or

tacrolimus association with PTDM or IFG was significant (P = .05),

Mantel-Haenszel test; OR, 4.9). The interaction between HCV and

immunosuppression therapy was primarily produced in the IFG group (HCV-positive;

P = .008; OR, 8).

Conclusion

We observed an association between the use of tacrolimus and the development of

PTDM or IFG. There is greater risk in HCV-positive patients, in particular in

relation to IFG. The choice of immunosuppressive treatment might be decided on

the basis of the patient's pretransplantation status.