New-onset diabetes mellitus after liver transplantation in the patients with acute liver failure: is there any effect of pretransplant hypoglycemia?

Abstract Background:The frequency of new-onset diabetes after transplant(NODAT) is 5-30% in liver transplant recipients. Aims: We aimed to analyze the frequency and predictors of NODAT in the patients undergoing liver transplantation(LTx) due to acute liver failure(ALF), and to investigate whether pretransplant hypoglycemia had any effect on NODAT. Methods: Adult patients undergoing LTx due to ALF were analyzed retrospectively. The patients with chronic liver failure or diabetes were excluded. We measured pretransplant random blood glucose(RBG) and posttransplant fasting blood glucose(FBG). NODAT was diagnosed according to principally 1 st month FBG (group 1:125 mg/dL). The participants were subgrouped according to age, gender, BM, etiology, antiviral medication, thyroid function, pretransplant RBG, donor type, immunosuppressive drug, common infection, and surgical complication. Results: A total of 91 patients were analyzed; mean age was 33.48(±13.35), and 52.7%(n=48) of them was female. The etiology was Budd-Chiari syndrome in 3(3.29%), acute viral hepatitis in 38(41.75%), drug or toxin-related in 21(23.07%), and other/unknown causes in 29(31.86%) patients. The ratio of NODAT was 26.98% on the 1 st month. NODAT group had a higher pretransplant RBG than the others. Pretransplant hypoglycemia did not have any effect on NODAT; however, pretransplant hyperglycemia increased the risk of NODAT by 4.065 times(p=0.018). Conclusions: We showed that pretransplant hyperglycemia increased the risk of NODAT by 4 times, but hypoglycemia did not affect. The frequency of NODAT decreased progressively during follow-up. We recommend perioperative glycemic control should be maintained as early as possible to manage NODAT; however, it might be complicated in such a clinical condition.