Relationship between donor liver steatosis and post-transplant diabetes mellitus in patients undergoing liver transplantation

Objective To discuss the risk factors of post-transplant diabetes mellitus (PTDM) in patients undergoing liver transplantation, especially donor liver steatosis. Methods Retrospectively analyze the data of 438 patients who received orthotopic liver transplantation from April, 2001 to December, 2008. The grade of donor liver steatosis was measured by histopathologic grading of non-alcoholic fatty liver disease in the guideline issued by Chinese Society of Hepatology. The donor liver function was evaluated by Child-Pugh grade system. According to the level of fasting plasma glucose after the operation, the patients were divided into non-PTDM group (n=298, 250 males and 48 females, mean age 48 years) and PTDM group (n=140, 120 males and 20 females, mean age 50 years). Univariate analysis was used to analyze the possible risk factors of PTDM, such as age, gender, fasting plasma glucose, body mass index, liver function before operation, steatosis of donor liver, anti-rejection drug, interleukin-2 receptor antagonist (IL-2RA) use. Multivariate logistic regression was employed based on the univariate analysis. Results There were 103 cases of donor liver steatosis in 298 non-PTDM patients (34.6%), and 62 donor liver steatosis in 140 PTDM patients (44.3%), no significant differences was found between the two groups(χ2=3.83, P=0.05). Univariate analysis showed that fasting plasma glucose before operation(F=23.38, P<0.05), liver function before operation, the use of IL-2RA and calcineurin inhibitor were significantly related to PTDM(χ2 values was 7.69, 8.30, 0.02, respectively; all P<0.05), but donor liver steatosis was at the critical level in relation to PTDM(χ2=3.83, P=0.05). While multivariate logistic regression indicated abnormal fasting plasma glucose before operation and donor liver steatosis had a positive relation with PTDM, the odds ratio (OR) value was 1.853 (P<0.01) and 1.80 (P<0.05), respectively. And the use of IL-2RA was negatively related with PTDM with a OR value of 0.43 (P<0.01). Conclusions Abnormal fasting plasma glucose before operation and donor liver steatosis are risk factors of PTDM, and use of IL-2RA can reduce the risk of PTDM; abnormal liver function before operation may increase the risk of PTDM, while the correlation between calcineurin inhibitor and PTDM needs further study. Key words: Diabetes mellitus; Liver transplantation; Post-transplant diabetes mellitus; Donor liver steatosis