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Prevalence, predictive factors, and survival outcome of new-onset diabetes after liver transplantation

View Article: PubMed Central - PubMed

ABSTRACT

The aim of the present nationwide population-based cohort study was to explore the prevalence, risk factors, and survival outcome of new-onset diabetes (NOD) in recipients after liver transplantation.

The National Health Insurance Research Database of Taiwan was searched for ICD-9-codes, 2248 patients who had received liver transplant without pretransplant diabetes from July 1, 1998 to December 31, 2012 were included in the study. The preoperative risks factors were considered and analyzed using logistic regression analysis, following adjustments for age and sex. All patients were followed up until the end of the study or death.

The final dataset included 189 patients with NOD and 2059 without diabetes after liver transplantation. The prevalence of NOD was 8.4% and in 64% NOD appeared in the first year after liver transplantation. Preoperative clinical events, alcoholic liver cirrhosis, and hepatic encephalopathy were the most important risk factors for NOD after liver transplantation. The mortality rate was lower in NOD recipients than in non-NOD recipients within 5 years.

In this study, we provide evidence that NOD recipients had better 5-year survival outcomes in this clinical population. The most important identifiable predictive factors for NOD after liver transplantation were alcoholic hepatitis, ascites, hepatic coma, and esophageal varices.

No MeSH data available.


Study design and flow chart of patient selection.
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Figure 1: Study design and flow chart of patient selection.

Mentions: The flow chart indicates the patient selection and identification procedure applied in this study (Fig. 1). LT recipients were identified from the NHIRD database using the ICD-9-CM codes V427 (LT status) and 996.82 (complications of transplanted liver), from July 1998, when LT was first covered by health insurance in Taiwan, to December 2012. Over this period, 4086 post-LT patients were registered in the NHIRD. This prospective group of patients was reviewed and any LT recipient who did not undergo transplantation in Taiwan was excluded. Applying these criteria, 1148 patients were excluded due to absence of an LT surgery code (identified as codes 505, 75020A, or 75020B). A total of 614 patients, who had been diagnosed as having diabetes mellitus (DM, ICD-9-CM 250, A181) before LT surgery and another 76 patients, in which the diagnosis of DM could not be confirmed before LT surgery, were also excluded. The final study cohort consisted of 2248 LT recipients (Fig. 1).


Prevalence, predictive factors, and survival outcome of new-onset diabetes after liver transplantation
Study design and flow chart of patient selection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998307&req=5

Figure 1: Study design and flow chart of patient selection.
Mentions: The flow chart indicates the patient selection and identification procedure applied in this study (Fig. 1). LT recipients were identified from the NHIRD database using the ICD-9-CM codes V427 (LT status) and 996.82 (complications of transplanted liver), from July 1998, when LT was first covered by health insurance in Taiwan, to December 2012. Over this period, 4086 post-LT patients were registered in the NHIRD. This prospective group of patients was reviewed and any LT recipient who did not undergo transplantation in Taiwan was excluded. Applying these criteria, 1148 patients were excluded due to absence of an LT surgery code (identified as codes 505, 75020A, or 75020B). A total of 614 patients, who had been diagnosed as having diabetes mellitus (DM, ICD-9-CM 250, A181) before LT surgery and another 76 patients, in which the diagnosis of DM could not be confirmed before LT surgery, were also excluded. The final study cohort consisted of 2248 LT recipients (Fig. 1).

View Article: PubMed Central - PubMed

ABSTRACT

The aim of the present nationwide population-based cohort study was to explore the prevalence, risk factors, and survival outcome of new-onset diabetes (NOD) in recipients after liver transplantation.

The National Health Insurance Research Database of Taiwan was searched for ICD-9-codes, 2248 patients who had received liver transplant without pretransplant diabetes from July 1, 1998 to December 31, 2012 were included in the study. The preoperative risks factors were considered and analyzed using logistic regression analysis, following adjustments for age and sex. All patients were followed up until the end of the study or death.

The final dataset included 189 patients with NOD and 2059 without diabetes after liver transplantation. The prevalence of NOD was 8.4% and in 64% NOD appeared in the first year after liver transplantation. Preoperative clinical events, alcoholic liver cirrhosis, and hepatic encephalopathy were the most important risk factors for NOD after liver transplantation. The mortality rate was lower in NOD recipients than in non-NOD recipients within 5 years.

In this study, we provide evidence that NOD recipients had better 5-year survival outcomes in this clinical population. The most important identifiable predictive factors for NOD after liver transplantation were alcoholic hepatitis, ascites, hepatic coma, and esophageal varices.

No MeSH data available.