New-Onset Diabetes Following Liver Transplant: Diabetes Treatment and Long Term Diabetic Complications — ASN Events
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  3. New-Onset Diabetes Following Liver Transplant: Diabetes Treatment and Long Term Diabetic Complications

New-Onset Diabetes Following Liver Transplant: Diabetes Treatment and Long Term Diabetic Complications (#283)

Angela ST Lee 1 , Lynda Molyneaux 1 , Maria Constantino 1 , Simone I Strasser 2 3 , Dennis Yue 1 3 , Ted Wu 1 , Jencia Wong 1 3
  1. Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  2. Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  3. Discipline of Medicine, University of Sydney, Sydney, NSW, Australia

New-onset diabetes after transplant (NODAT) is a common complication of liver transplantation. It has been generally thought that diabetes in transplant recipients is not associated with the complications of diabetes as seen in the non-transplant population1 . However, with improving post-transplant survival, long-term management of diabetic complications becomes increasingly relevant. The prevalence of both micro and macro- vascular diabetic complications in NODAT of long duration post liver transplant has not been widely reported. Using data extracted from the RPA Diabetes Centre database, we compared the long term prevalence of diabetic complications in 21 patients with NODAT after liver transplant, compared with 147 non-transplant subjects with type 2 diabetes, matched 1:7 for age, gender, duration of diabetes, ethnicity and HbA1C.

The groups had a long duration of diabetes (median> 7 years) and median duration after transplant was 12 years (Table 1).  The prevalence of microvascular complications was not significantly different between the NODAT and non-transplant groups: p≥0.2 for retinopathy, albuminuria and biothesiometer Z score. The prevalence of macrovascular complications was also not significantly different. Glycaemic control was excellent in this NODAT group (HbA1C % mean± SD, 6.9±1.4%) despite a high prevalence of calcineurin inhibitor and corticosteroid use. However,  NODAT required more insulin treatment (combined insulin and oral hypoglycemic agents 33.3% vs 17.7%, or insulin alone 28.6% vs 4.1%) than those without transplant (p<0.0001).

Patients with NODAT after liver transplant have a similar prevalence of microvascular and macrovascular complications compared to a non-transplant diabetic population of similar diabetes duration and metabolic control. This implies a similar long term risk for diabetic complications and has relevance for complications screening recommendations. Furthermore, more intensive diabetic therapy appears to be required to maintain glycaemic control and  to prevent diabetic complications.

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  1. J A Davidson et al. New-Onset Diabetes After Transplantation 2003 International Consensus Guidelines An endocrinologist’s view. Diabetes Care 2004 27, 805-812