Pre-existing diabetes (PED) in liver transplant patients (LTP)

Pre-existing Diabetes (PED) in Liver Transplant Patients (LTP) Pre-existing and post-transpla Pre-existing and post-transplant diabetes in LTP can heavily impact on recipients[apos] morbidity and mortality. However, little and inconsistent information is available on the prevalence and characteristics of PED in LTP. We studied 203 patients (age: 52[plusmn]9 yrs, M/F: 157/46, BMI: 24.6[plusmn]3 Kg/m2) who entered the waiting list for orthotopic liver transplantation in our institution. Based on clinical history and fasting plasma glucose (FPG) concentration, 73 patients (36%) had PED (age: 55[plusmn]8 yrs, M/F: 60/13, BMI: 25[plusmn]2.8 kg/m2; diabetes duration 6[plusmn]7 yrs), and 130 patients (64%) normal FPG (N, age: 51[plusmn]9 yrs, M/F: 97/33, BMI: 24.4[plusmn]3.1 kg/m2). Compared with N, patients with PED were older (p[lt]0.01), with more frequent family history of diabetes (42% vs 28%, p[lt]0.05) and higher BMI (p[lt]0.03); in addition, the prevalence of hepatitis C virus (HCV) infection tended to be higher (52 vs 44%, p=0.32). Out of patients with PED, 37 (51%) were on insulin, 8 (11%) on oral agents and 28 (38%) on diet alone. PED average glycemic control was fair, with FPG and A1c of 157[plusmn]66 mg/dl and 6.7[plusmn]1.4%, respectively, which was associated (in patients on oral agents or diet alone) with lower insulin sensitivity (HOMA1-IR: Homeostatic Model Assessment-Insulin Resistance; 16[plusmn]28.6 vs 4.85[plusmn]3.37 p[lt]0.001) and reduced beta-cell function (HOMA1-%B: Homeostatic Model Assessment-Beta-Cell Function; 167[plusmn]112 vs 293[plusmn]216 p[lt]0.001). Diabetic retinopathy was found in 9 patients (12%), with previous laser treatment in 3 cases. In conclusion, the prevalence of PED in LTP is very high, and is associated with higher age, positive family history and increased BMI; insulin is the most common form of treatment, and non-insulin treated PED is characterized by lower insulin sensitivity and reduced beta-cell function; diabetic complications may be present in PE