Outcomes in patients with diabetes 10 years after liver transplantation

Highlights The present study shows a significant relationship between diabetes and the risk of liver graft rejection, as well as between diabetes and the risk of cardiovascular events. A tendency for lower survival in diabetic patients was observed; however, this was not confirmed in the Cox regression model. Background There are discrepancies between studies regarding the effect of diabetes mellitus on morbidity and mortality in patients undergoing liver transplantation. The aim of the present study was to compare mortality, risk of liver graft rejection, and cardiovascular events in patients with and without diabetes undergoing liver transplantation over a 10‐year follow‐up period. Methods A retrospective study was performed on 183 patients who underwent liver transplantation in 2005 and 2006. Mortality and morbidity data were collected until 2016, including information on mortality and survival time, graft rejection and graft survival time, coronary heart disease, stroke, and peripheral arterial ischemia. Results During the follow‐up, 41.3% and 27.8% of patients in the groups with and without diabetes, respectively, died. A trend for lower survival time was observed in patients with diabetes, although this effect was not confirmed by the Cox regression model. There was an increased risk of graft rejection in the group with diabetes compared with the group without diabetes ( P < 0.001). In the survival analysis, diabetes was associated with reduced graft survival time ( P = 0.001). Cardiovascular events were also more likely in the group with diabetes ( P = 0.005). Conclusions In the present study diabetes was associated with a higher risk of liver graft rejection and cardiovascular events. There was also a trend for higher mortality, although the effect was not statistically significant. These findings suggest that patients with diabetes require a more rigorous pretransplant evaluation and closer monitoring after transplantation in order to try to reduce associated complications. 摘要 背景 目前有关糖尿病对肝移植患者发病率与死亡率影响的不同研究结果之间还存在差异。当前这项研究旨在肝移植术后超过10年的随访期内比较合并与不合并糖尿病的患者的死亡率、肝移植排斥风险以及心血管事件。 方法 对183名于2005–2006年间接受过肝移植术的患者进行回顾性研究。收集了直到2016年的发病率与死亡率数据,包括死亡率与生存时间、移植排斥与移植物存活时间、冠心病、中风以及外周动脉缺血等信息。 结果 随访期间,在合并与不合并糖尿病的患者组中分别有41.3%与27.8%的患者死亡。在合并糖尿病的患者组中观察到的生存时间具有更低的趋势,虽然Cox回归模型并没有证实这种效应。与不合并糖尿病的患者组相比,合并糖尿病的患者组出现排斥反应的风险明显增加(P < 0.001)。在生存分析中,糖尿病与移植物存活时间缩短相关(P = 0.001)。心血管事件在合并糖尿病的患者组中也更有可能出现(P = 0.005)。 结论 在当前这项研究中,糖尿病与肝移植排斥反应以及心血管事件风险增加都有相关性。死亡率也有升高的趋势,虽然这种效应没有显著的统计学意义。这