New onset of diabetes after transplantation is associated with improved patient survival after liver transplantation due to confounding factor

Abstract Background The influence of NODAT on survival of liver transplant recipients has not been clarified. Therefore, we evaluated the effect of NODAT on survival in LT recipients. Methods Data from 352 LT patients were totally analyzed. 97 patients with pretransplant diabetes mellitus were excluded, and 255 patients without diabetes mellitus at time of transplantation were included. Results NODAT was diagnosed in 41 patients (16.1%). There was no difference in frequency of NODAT according to the etiology of liver cirrhosis. NODAT was associated with a higher body weight (p = 0.004) and BMI (p = 0.002) 5 years after LT, but not with weight gain (p = 0.201) or increase in BMI (p = 0.335) 5 years after LT. HbA1c 5 years after LT was significantly higher in patients with NODAT (p = 0.001), but mean HbA1c still remained lower than 6.5% (6.4(± 1.2) %). Patients with NODAT showed better survival rates (log rank: p = 0.002) compared to LT recipients without diabetes. According to all existing knowledge of diabetes mellitus (DM) better survival cannot be a direct effect of this disease. Our results are rather influenced by an not known confounding factor (possibly recovery from cachexia) associated with better survival and NODAT, while complications of NODAT will not appear during the relatively short postoperative time and observation period (mean follow up 6.08 (± 2.67) years). Conclusion NODAT is frequently diagnosed in LT recipients and is associated with an improved 5 year survival after LT due to a not exactly known confounding factor.