Sustained Virological Response Is Associated with a Decreased Risk of Posttransplant Diabetes Mellitus in Liver Transplant Recipients with Hepatitis C-Related Liver Disease

• Type of Material: Article
• Authors: Giorgio Roccaro, Emory University; Robert Mitrani, University of Pennsylvania; Wei-Ting Hwang, University of Pennsylvania; Kimberly A. Forde, University of Pennsylvania; K. Rajender Reddy, University of Pennsylvania
• Language: English
• Date: 2018-12-01
• Publisher: WILEY
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2018 by the American Association for the Study of Liver Diseases.
• Final Published Version (URL): http://dx.doi.org/10.1002/lt.25351
• Title of Journal or Parent Work: LIVER TRANSPLANTATION
• Volume: 24
• Issue: 12
• Start Page: 1665
• End Page: 1672
• Grant/Funding Information: This study was supported by the NIH T32-DK007740–19.
• Keywords: Surgery; IMPACT; Life Sciences & Biomedicine; Gastroenterology & Hepatology; CARDIOVASCULAR EVENTS; VIRUS-INFECTION; Transplantation; Science & Technology
• Research Categories: Biology, Virology; Health Sciences, Medicine and Surgery

Abstract

Posttransplant diabetes mellitus (PTDM), an increasingly recognized complication of solid organ transplantation, is associated with increased morbidity and mortality following liver transplantation (LT). Hepatitis C virus (HCV) infection is a consistent and modifiable risk factor for PTDM. Prior studies have demonstrated improvement in glucose metabolism following sustained virological response (SVR). However, the effect of SVR on the incidence of PTDM has not been previously investigated in a large cohort of LT recipients. We performed a single-center retrospective cohort study of LT recipients with HCV from January 1, 2010 to June 30, 2015 to compare the risk of sustained posttransplant diabetes mellitus (s-PTDM) prior to and following SVR. SVR was treated as a discrete time varying exposure. The s-PTDM was defined as de novo diabetes mellitus following LT of a >6-month duration. Univariate and multivariate Cox proportional hazards models were used to compare crude and adjusted time to s-PTDM prior to and following SVR. There were 256 eligible LT recipients analyzed. Median follow-up was 41.2 months. Overall, 31 (12.1%) and 178 (69.5%) patients achieved SVR prior to LT and following LT, respectively. During follow-up, 71 (27.7%) patients developed s-PTDM. The incidence of s-PTDM was greatest in the first year after LT. After adjustment for potential confounders, SVR was associated with a significantly reduced risk of s-PTDM (HR, 0.40; P = 0.048). In conclusion, eradication of HCV is independently associated with a reduced incidence of s-PTDM. This benefit appears to be most influenced by pre-LT SVR and persists throughout the post-LT period. Given the association between PTDM and posttransplant morbidity and mortality, these data provide another motivator for pre-LT or early post-LT treatment of HCV.