Abstract
This retrospective study aimed to investigate the effect of diabetes mellitus (DM) on the risks of end-stage kidney disease (ESKD) and post-liver transplantation (post-LT) mortality. Using data from the National Health Insurance Research Database, Taiwan, 3,489 patients who received a LT between 1 January 2005, and 31 December 2015, were enrolled in this study and divided into the pre-existing DM, post-LT DM (PLTDM), and without DM groups. All subjects were followed up from 1 year after LT to the index date for ESKD, and the occurrence of death, or until 31 December 2016. Of the 3,489 patients with LT, 1,016 had pre-existing DM, 215 had PLTDM, and 2,258 had no DM pre- or post-LT. The adjusted HRs of ESKD were 1.77 (95% Confidence Interval [CI], .78–3.99) and 2.61 (95% CI, 1.63–4.18) for PLTDM group and pre-existing DM group compared to without DM group, respectively. For the risk of death, the adjusted HRs were 1.05 (95% CI, .72–1.55) and 1.28 (95% CI, 1.04–1.59) for PLTDM group and pre-existing DM group compared to those without DM group, respectively. The sensitivity analysis for the risk of ESKD and death also revealed the consistent result. Pre-existing DM has significant increase the risk of post-LT ESKD and mortality. The role of PLTDM should be explored to explain postoperative morbidity and mortality.
Highlights
Liver transplantation (LT) is an effective strategy for treating patients with end-stage liver disease and some types of hepatocellular carcinomas [1]
The relatively limited number of studies examining the impact of pre-existing diabetes mellitus (DM) and post-liver transplantation (Post-LT) DM (PLTDM) on longterm renal outcomes and mortality, especially the risks of end-stage kidney disease (ESKD), prompted us to conduct this retrospective study to investigate the influence of DM on the risks of ESKD and all-cause mortality post-LT by using patient data from the National Health Insurance Research Database (NHIRD) in Taiwan
After excluding patients with missing age and sex data, age
Summary
Liver transplantation (LT) is an effective strategy for treating patients with end-stage liver disease and some types of hepatocellular carcinomas [1]. An improvement in the early post-LT survival rate underscores the importance of understanding the causes and risk factors for late post-LT mortality. Renal dysfunction is common in recipients of liver transplant and is a known risk factor for mortality in patients who have undergone LT [4, 5]. Post-LT DM (PLTDM) develops in up to 30% of liver transplant recipients, negatively affecting long-term survival [9]. The relatively limited number of studies examining the impact of pre-existing DM and PLTDM on longterm renal outcomes and mortality, especially the risks of ESKD, prompted us to conduct this retrospective study to investigate the influence of DM on the risks of ESKD and all-cause mortality post-LT by using patient data from the National Health Insurance Research Database (NHIRD) in Taiwan
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