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Cited by 4Organ Transplantation Techniques and OutcomesLiver Disease Diagnosis and TreatmentLiver Disease and Transplantation

The clinical implications of pre-liver transplant diabetes on post-liver transplant outcomes in patients with NASH: analysis of the UNOS database

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Lee, David Uihwan, Han, John, Lee, Ki Jung, Kwon, Jean, Fan, Gregory Hongyuan, Jung, Daniel, Urrunaga, Nathalie H.·2022·Hepatology International
DOI 10.1007/s12072-022-10414-8PMC PMC9939002
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Abstract

Background and aims The presence of perioperative diabetes may lead to increased mortality risks following liver transplant (LT) in patients with non-alcoholic steatohepatitis (NASH). This risk factor was evaluated using a UNOS-STAR national database.Methods The UNOS-STAR liver transplant registry 2005-2019 was used to select patients with NASH (including cryptogenic liver disease). The following populations were excluded: those younger than 18 years old and those with living donors/dual transplants. Selected patients were stratified into those with and without pre-LT diabetes and compared to the individual mortality endpoints using iterative Cox analyses.Results 6324 recipients with and 8251 without diabetes were selected. The median follow-up time was 3.07 years. Those with diabetes were older (58.50 vs. 54.50 years, p < 0.001), were more likely to be Hispanic or Asian, and had higher BMI than the non-diabetics (31.10 vs. 29.70 kg/m 2 p < 0.001); however, there was no difference in gender (female 41.9 vs. 43.1% p = 0.170). Compared to non-diabetics, recipients with diabetes had a higher rate of all-cause mortality (61.68 vs. 47.80 per 1000 person-years). In multivariate iterations, pre-LT diabetes was associated with all-cause mortality (aHR 1.19 95% CI 1.11-1.27) as well as deaths due to cardiac (p = 0.014 aHR 1.24 95% CI 1.04-1.46) and renal causes (p = 0.039 aHR 1.38 95% CI 1.02-1.87).Conclusion The presence of pre-LT diabetes is associated with all-cause mortality and deaths due to cardiac and renal causes following LT. The findings warrant an early preoperative screening procedure to ensure that patients with diabetes have their metabolic risk factors optimized prior to LT.

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  • Individuals with MASLD and T2D are at particular risk for all-cause mortality and deaths due to cardiac and renal causes following liver transplantation.

    “Individuals with MASLD and T2D are at particular risk for all-cause mortality and deaths due to cardiac and renal causes following liver transplantation. 483”

    From EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). (2024) · cites this paper as [483]

    The Discussion and Results (page numbers not provided) report that pre-transplant diabetes in liver-transplant recipients with NASH was associated with higher all-cause mortality and deaths from cardiac and renal causes. The study selected patients with NASH and reports diabetes without specifying type 2, so it does not establish the claim for the broader MASLD population specifically with T2D. (LLM, conf=0.87)

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Authors
Lee, D. U., Han, J., Lee, K. J., Kwon, J., Fan, G. H., Jung, D., & Urrunaga, N. H.
Affiliations
  • University of Maryland, Baltimore (US)
  • Tufts University (US)
  • University of Missouri–Kansas City (US)
Corresponding author
Lee, David Uihwan
ORCID
Venue
Hepatology International
Publisher
Springer Science and Business Media LLC
Published
2022-09-11
Volume
16
Issue
6
Pages
1448-1457
ISSN
  • 1936-0533 (ISSN-L)
  • 1936-0541
DOI
10.1007/s12072-022-10414-8
PMC
PMC9939002
OpenAlex
W4295875422
Cited by
4
References
55
Citations by year
2024: 2 · 2023: 2
FWCI
0.95
Type
journal article
Language
en
Open access
Licence
Locations
  • Hepatology International (publishedVersion)
  • Research Square (acceptedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (NIH NIDDK T32 DK067872-17)
Topics
  • Health Sciences › Medicine › Surgery › Organ Transplantation Techniques and Outcomes
  • Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
  • Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
Keywords
nonalcoholic steatohepatitis, liver transplantation, post-transplant mortality, all-cause mortality, cardiac mortality, renal mortality, preoperative screening, cryptogenic liver disease
MeSH terms
Adolescent, Diabetes Mellitus, Female, Humans, Retrospective Studies, Risk Factors, Liver Transplantation, Non-alcoholic Fatty Liver Disease

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