간이식 후 발생한 당뇨병의 지속 유발인자 = Posttransplant Diabetes Mellitus after Liver Transplantation: Risk Factors for Persistence

다국어 초록 (Multilingual Abstract)

Background: The leading causes of late deaths after transplant were graft failure, malignancy, cardiovascular disease and renal failure. Diabetes mellitus (DM) is one of the greatest contributing factors to these late events, but also one of the most modifiable.
This study was conducted to identify the incidence and time course of posttransplant diabetes mellitus (PTDM) after liver transplantation (LT) and evaluate the factors related to the development and reversal of PTDM.
Methods: Patients who underwent LT between 2002 and 2015 at Ulsan University Hospital, were followed for more than 3 months and had no history of preoperative DM were the subject of this study. The authors investigated the incidence and time course of PTDM. Recipient factors, donor factors and postoperative factors presumed to contribute to the development and reversal of PTDM were investigated. Moreover, the effects of PTDM on the survival of liver transplant recipients were also investigated.
Results: PTDM developed in 13 (16.5%) of 79 patients who fulfilled the inclusion criteria a median of 35 days after LT. There were no significant factors contributing to the development of PTDM. Five of the 13 PTDM patients recovered from the diabetic condition 5 to 38 months after the diagnosis of PTDM. Higher postoperative magnesium levels (P=0.022), development of acute cellular rejection (P=0.01), and steroid pulse therapy (P=0.045) were the predictive factors for reversal of PTDM. PTDM had no impact on patient survival (P=0.529).
Conclusions: PTDM usually developed soon after LT operation and was reversible in 41% of the cases, especially when it is associated with steroid pulse therapy for acute cellular rejection. The association between serum magnesium level and reversibility of PTDM after LT needs further study to clarify the cause-and-effect relationship.

참고문헌 (Reference)

1 Bloom RD, "Transplant-associated hyperglycemia" 22 : 39-51, 2008

2 de Boccardo G, "The burden of chronic kidney disease in long-term liver transplant recipients" 40 : 1498-1503, 2008

3 Simmons LR, "Steroid-induced diabetes: is it just unmasking of type 2 diabetes" 2012 : 910905-, 2012

4 Arner P, "Some characteristics of steroid diabetes: a study in renal-transplant recipients receiving high-dose corticosteroid therapy" 6 : 23-25, 1983

5 Hur KY, "Risk factors associated with the onset and progression of posttransplantation diabetes in renal allograft recipients" 30 : 609-615, 2007

6 Shapiro R, "Reversibility of tacrolimus-induced posttransplant diabetes: an illustrative case and review of the literature" 29 : 2737-2738, 1997

7 Vincenti F, "Results of an international, randomized trial comparing glucose metabolism disorders and outcome with cyclosporine versus tacrolimus" 7 : 1506-1514, 2007

8 Neylan JF, "Racial differences in renal transplantation after immunosuppression with tacrolimus versus cyclosporine. FK506 Kidney Transplant Study Group" 65 : 515-523, 1998

9 Sharif A, "Proceedings from an international consensus meeting on posttransplantation diabetes mellitus: recommendations and future directions" 14 : 1992-2000, 2014

10 안화영, "Predictive Factors Associated with the Reversibility of Post-transplantation Diabetes Mellitus Following Liver Transplantation" 대한의학회 24 (24): 567-570, 2009

11 Montori VM, "Posttransplantation diabetes: a systematic review of the literature" 25 : 583-592, 2002

12 Maes BD, "Posttransplantation diabetes mellitus in FK-506-treated renal transplant recipients: analysis of incidence and risk factors" 72 : 1655-1661, 2001

13 Shivaswamy V, "Post-transplant diabetes mellitus: causes, treatment, and impact on outcomes" 37 : 37-61, 2016

14 Zaccardi F, "Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective" 92 : 63-69, 2016

15 Rodriguez-Moran M, "Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subjects: a randomized double- blind controlled trial" 26 : 1147-1152, 2003

16 Harada N, "New-onset diabetes mellitus developing in Asian adult living donor liver transplant recipients: a single-center experience" 20 : 634-638, 2013

17 Davidson J, "New-onset diabetes after transplantation: 2003 International consensus guidelines. Proceedings of an international expert panel meeting. Barcelona, Spain, 19 February 2003" 75 (75): SS3-SS24, 2003

18 Heisel O, "New onset diabetes mellitus in patients receiving calcineurin inhibitors: a systematic review and meta-analysis" 4 : 583-595, 2004

19 Yadav AD, "New onset diabetes mellitus in living donor versus deceased donor liver transplant recipients: analysis of the UNOS/OPTN database" 2013 : 269096-, 2013

20 Benhamou PY, "Natural history, prognosis, and management of transplantation-induced diabetes mellitus" 28 : 166-175, 2002

21 Cha BS, "Management of posttransplantation diabetes mellitus (PTDM)" 25 : 8-14, 2011

22 Koivisto M, "Magnesium depletion in chronic terminal liver cirrhosis" 16 : 325-328, 2002

23 Pageaux GP, "Long-term outcomes of liver transplantation: diabetes mellitus" 15 (15): S79-S82, 2009

24 Cole EH, "Impact of acute rejection and new-onset diabetes on long-term transplant graft and patient survival" 3 : 814-821, 2008

25 Jindal RM, "Impact and management of posttransplant diabetes mellitus" 70 (70): SS58-SS63, 2000

26 Huang JW, "Hypomagnesemia and the risk of new-onset diabetes mellitus after kidney transplantation" 27 : 1793-1800, 2016

27 White DL, "Hepatitis C infection and risk of diabetes: a systematic review and meta-analysis" 49 : 831-844, 2008

28 Hjelmesaeth J, "Glucose intolerance after renal transplantation depends upon prednisolone dose and recipient age" 64 : 979-983, 1997

29 van Hooff JP, "Evaluating mechanisms of post-transplant diabetes mellitus" 19 (19): vi8-vi12, 2004

30 Kawaguchi T, "Clearance of HCV improves insulin resistance, beta- cell function, and hepatic expression of insulin receptor substrate 1 and 2" 102 : 570-576, 2007

31 Korean Network for Organ Sharing, "Annual report of the transplant 2014" KONOS

32 Pageaux GP, "Analysis of well-being after organ transplantation in a large cohort of French patients" 34 : 1687-1688, 2002

33 Dopazo C, "Analysis of adult 20-year survivors after liver transplantation" 9 : 461-470, 2015