Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort

A Fernández-Ramírez; A Olivas-Martinez; J Ruiz-Manriquez; E Kauffman-Ortega; C Moctezuma-Velázquez; E Marquez-Guillen; A G Contreras; M Vilatobá; E González-Flores; R Cruz-Martínez; N C Flores-García; I García-Juárez

doi:10.1016/j.rgmxen.2023.06.002

Posttransplantation diabetes mellitus after liver transplant and the impact of family history of diabetes in a Mexican cohort

Rev Gastroenterol Mex (Engl Ed). 2023 Oct 17:S2255-534X(23)00112-3. doi: 10.1016/j.rgmxen.2023.06.002. Online ahead of print.

Affiliations

¹ Departamento de Medicina Interna, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
² Departamento de Bioestadística, Universidad de Washington, Seattle, WA, United States.
³ Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁴ Departamento de Cirugía y Trasplante, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁵ Centro de Atención Integral del Paciente con Diabetes (CAIPaDi), Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
⁶ Unidad de Hepatología y Trasplante Hepático, Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. Electronic address: drinter77@gmail.com.

PMID: 37858455
DOI: 10.1016/j.rgmxen.2023.06.002

Abstract

Introduction and aims: Posttransplantation diabetes mellitus (PTDM) is a serious long-term complication that has a negative impact on graft and patient survival. The purpose of the present study was to describe the incidence of PTDM in a Mexican cohort and evaluate its association with a previous family history of diabetes (FHD).

Methods: A retrospective single-center cohort study was conducted on patients undergoing liver transplantation (LT). The primary outcome was time from LT to PTDM. The diagnosis of PTDM was established using the ADA criteria. A mediation analysis that used adjusted Cox regression models and considered pretransplant prediabetes a mediator was performed, to determine the total effect and direct effect of FHD on PTDM.

Results: A total of 152 patients were included, with a median follow-up time of 41 months; 19.2% (n = 29) had pretransplant diabetes. During the follow-up time, 15% of patients developed PTDM (n = 23), with an incidence rate of 4.71 cases/100 person-years. PTDM was significantly higher in patients with FHD, compared with those with no FHD (8.72 cases/100 person-years vs 2.04 cases/100 person-years, respectively; p = 0.001). The adjusted hazard ratio of PTDM for FHD was 4.14 (95% CI 1.60-10.7), p = 0.005) and 3.48 (95% CI 1.35-9.01, p = 0.010), when further controlled for pretransplant prediabetes.

Conclusion: The occurrence of PTDM was similar to that reported in most international studies. As with type 2 diabetes, family history plays an important role in the development of PTDM, even after accounting for pretransplant prediabetes. Patients with FHD should undergo a stricter metabolic program.

Keywords: Antecedente familiar; DMPT; Diabetes; Family history; Liver transplantation; Mexican; Mexicanos; NODAT; PTDM; Trasplante hepático.