The impact of diabetes mellitus and glycemic control on clinical outcomes following liver transplant for hepatitis C

Hepatitis C is the leading indication for liver transplantation in the USA and recurrence is universal. The impact of preexisting diabetes, new-onset diabetes after transplant (NODAT), and glycemic control on fibrosis progression has not been studied. This retrospective longitudinal cohort study included adult liver recipients with hepatitis C transplanted between 2000 and 2011. Patients were divided into three groups: preexisting diabetes (n=41), NODAT (n=59), and no diabetes (n=103). Patients with preexisting diabetes (70%) or NODAT (59%) were more likely to develop hepatitis C recurrence (stage 1 fibrosis), as compared to non-diabetics (36%, p=0.006). There was also a trend toward a higher incidence of at least Stage 2 fibrosis (36% and 48% vs. 23%, respectively; p=0.063). Patients with tight glycemic control had a lower rate of Stage 2 fibrosis development (78% vs. 60%, p=0.027), while those with good control (<150mg/dL) also had lower rates of Stage 2 fibrosis (84% vs. 62%, p=0.004). Multivariable analysis verified a decreased rate of recurrence for patients with blood glucose <138mg/dL (p=0.021), after controlling for confounders. These results demonstrate that diabetes is strongly associated with an increased risk of hepatitis C virus-related fibrosis development and glycemic control may reduce the risk and severity of recurrence.