Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
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 Universit...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-08-01
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| Series: | Therapeutics and Clinical Risk Management |
| Subjects: | |
| Online Access: | https://www.dovepress.com/impact-of-immunosuppressant-therapy-on-new-onset-diabetes-in-liver-tra-peer-reviewed-article-TCRM |
| _version_ | 1819008811906629632 |
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| author | Liu FC Lin HT Lin JR Yu HP |
| author_facet | Liu FC Lin HT Lin JR Yu HP |
| author_sort | Liu FC |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-21T00:46:25Z |
| format | Article |
| id | doaj.art-2eb01fd8c553406a83c4267c0da99e5b |
| institution | Directory Open Access Journal |
| issn | 1178-203X |
| language | English |
| last_indexed | 2024-12-21T00:46:25Z |
| publishDate | 2017-08-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Therapeutics and Clinical Risk Management |
| spelling | doaj.art-2eb01fd8c553406a83c4267c0da99e5b2022-12-21T19:21:30ZengDove Medical PressTherapeutics and Clinical Risk Management1178-203X2017-08-01Volume 131043105134316Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipientsLiu FCLin HTLin JRYu HPFu-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 outcomehttps://www.dovepress.com/impact-of-immunosuppressant-therapy-on-new-onset-diabetes-in-liver-tra-peer-reviewed-article-TCRMNew-onset diabetesLiver transplantationImmunosuppressant |
| spellingShingle | Liu FC Lin HT Lin JR Yu HP Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients Therapeutics and Clinical Risk Management New-onset diabetes Liver transplantation Immunosuppressant |
| title | Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients |
| title_full | Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients |
| title_fullStr | Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients |
| title_full_unstemmed | Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients |
| title_short | Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients |
| title_sort | impact of immunosuppressant therapy on new onset diabetes in liver transplant recipients |
| topic | New-onset diabetes Liver transplantation Immunosuppressant |
| url | https://www.dovepress.com/impact-of-immunosuppressant-therapy-on-new-onset-diabetes-in-liver-tra-peer-reviewed-article-TCRM |
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