Diabetes mellitus posterior a trasplante hepático y el impacto del antecedente familiar de diabetes en una cohorte mexicana

Abstract

Introduction and aimsPosttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD). MethodsA retrospective single-center cohort study was conducted on patients undergoing liver transplantation. The primary outcome was time from liver transplantation to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM. ResultsA total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n=29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n=23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; P=.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), P=.005) and 3.48 (95% CI 1.35-9.01, P=.010), when further controlled for pretransplant prediabetes. ConclusionThe occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.