Back to Journals » Therapeutics and Clinical Risk Management » Volume 13

Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients

Authors Liu FC, Lin HT, Lin JR, Yu HP

Received 22 May 2017

Accepted for publication 2 August 2017

Published 18 August 2017 Volume 2017:13 Pages 1043—1051

DOI https://doi.org/10.2147/TCRM.S142348

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Professor Deyun Wang

Fu-Chao Liu,1,2,* Huan-Tang Lin,1,2,* Jr-Rung Lin,1–3 Huang-Ping Yu1,2

1Department of Anesthesiology, Chang Gung Memorial Hospital, 2College of Medicine, 3Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan

*These authors contributed equally to this work

Abstract: This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140 patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications before prescribing immunosuppressants for liver transplant recipients.

Keywords: new-onset diabetes, liver transplantation, immunosuppressant, population-based study, clinical outcome

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]

 

Other articles by this author:

Immunosuppressants and new onset gallstone disease in patients having undergone renal transplantation

Liu FC, Ting PC, Lin JR, Yu HP

Therapeutics and Clinical Risk Management 2017, 13:1391-1398

Published Date: 13 October 2017

Impact of preoperative chronic renal failure on liver transplantation: a population-based cohort study

Chung PC, Chen HP, Lin JR, Liu FC, Yu HP

Therapeutics and Clinical Risk Management 2016, 12:1855-1860

Published Date: 14 December 2016