An analysis of risk factors for the development of diabetes mellitus after orthotopic liver transplantation in adults

Abstract

Objective To investigate risk factors for the development of post-transplant diabetes mellitus (PTDM) in patients undergoing orthotopic liver transplantation. Methods We included 293 patients who underwent orthotopic liver transplantation at The Affiliated Hospital of Qingdao University from July 1, 2017 to January 31, 2023. According to whether PTDM occurred, the patients were divided into PTDM group (n=66) and non-PTDM group (n=227). Significantly different clinical para-meters between the two groups were included in a multivariable logistic regression model to determine independent risk factors for PTDM. The impact of PTDM on the survival rate of the patients was analyzed using a Kaplan-Meier survival curve. Results The incidence rate of PTDM among the patients was 22.5%. The PTDM group and non-PTDM group differed significantly in age, the percentage of patients with a history of hypertension, preoperative fasting blood glucose level, preoperative serum total cholesterol level, preoperative serum low-density lipoprotein level, the percentage of patients treated with cyclosporine after surgery, and the percentage of patients treated with anti-rejection regimen C (cyclosporine alone or combined with mycophenolate or sirolimus) or D (mycophenolate or sirolimus alone) after surgery (t=-3.191,U=-5.668--2.559,χ2=3.922-5.689,P<0.05). The multivariable logistic regression analysis showed that age >46 years, a history of hypertension, preoperative fasting blood glucose level >6.1 mmol/L, preoperative serum low-density lipoprotein level >3.12 mmol/L, postoperative use of anti-rejection regimen C (cyclosporine alone or combined with mycophenolate or sirolimus) were independent risk factors for the occurrence of PTDM (P<0.05). The survival curve showed that the occurrence of PTDM significantly decreased the 5-year survival rate of the patients (P<0.05). Conclusion Age >46 years, a history of hypertension, preoperative fasting blood glucose level >6.1 mmol/L, preoperative serum low-density lipoprotein level >3.12 mmol/L, and postoperative anti-rejection treatment with cyclosporine alone or combined with mycophenolate or sirolimus are independent risk factors for adult PTDM.

Keywords

• liver transplantation|postoperative complications|diabetes mellitus|risk factors