Sustained Posttransplantation Diabetes Is Associated With Long-Term Major Cardiovascular Events Following Liver...

Area of Science:

• Hepatology
• Cardiology
• Endocrinology

Background:

• Cardiovascular disease (CVD) is a primary cause of mortality in liver transplant (LT) recipients.
• Posttransplantation metabolic complications, including diabetes, are rising, potentially impacting long-term survival.
• The differential risk of major cardiovascular events (MCEs) based on diabetic status post-LT remains unclear.

Purpose of the Study:

• To investigate the association between varying diabetic states and the incidence of MCEs in liver transplant recipients.
• To compare MCE risk among patients without diabetes, with pretransplantation diabetes, and with de novo transient or sustained posttransplantation diabetes.

Main Methods:

• Retrospective cohort study of 994 liver transplant recipients from 2003-2013.
• Categorization of patients into four diabetic groups: no diabetes, pretransplantation diabetes, de novo transient posttransplantation diabetes, and de novo sustained posttransplantation diabetes.
• Analysis of MCE incidence over a median follow-up of 54.7 months, with adjustments for demographic and clinical variables.

Main Results:

• 12% of all patients experienced a MCE during the follow-up period.
• Sustained posttransplantation diabetes was the sole diabetic state significantly associated with an increased risk of MCEs (aHR 1.95; 95% CI 1.20-3.18).
• Cumulative incidence of MCEs at 5 and 10 years was 13% and 27%, respectively, for patients with sustained posttransplantation diabetes.

Conclusions:

• Sustained de novo diabetes mellitus after liver transplantation poses the highest long-term risk for major cardiovascular events.
• While pretransplantation diabetes is a known risk factor, sustained posttransplantation diabetes represents a critical, modifiable risk factor for CVD in LT recipients.
• Effective management of de novo diabetes post-LT is crucial for mitigating cardiovascular morbidity and mortality and improving long-term life expectancy.