Liver Grafts From Donors With Diabetes Mellitus Associated With Poor Outcomes Early After Transplant

Recipients of liver transplants from donors with diabetes mellitus (DM) were found to have a higher risk for hepatic artery thrombosis (HAT) and decreased 90-day graft survival compared with recipients of grafts from donors without DM, according to study data published in Transplant International.

The retrospective cohort study included consecutive patients who underwent liver transplantation with a graft from a donor with DM from January 1, 1996 to December 31, 2016. The transplant recipients were randomly matched with 2 individuals who each received a liver from a donor without DM. The primary outcome was early post-transplant outcome, which included the incidence of primary non-function (PNF), HAT, and 90-day graft survival. 

In this study, PNF was defined as non-life-sustaining liver function that either required retransplantation or led to death within 7 days of transplantation. At the 3-year follow-up, the incidence rate of PNF was 5.8% for recipients of grafts from donors with DM vs 2.9% for recipients of non-DM donor grafts (P =.31). Recipients of grafts from donors with DM had a significantly higher incidence of HAT (8.7% vs 2.2%, P =.03) and lower 90-day graft survival (88.4%; 95% CI, 70.9–91.1; vs 96.4%; 95% CI, 89.6–97.8; P =.03).

In the Cox model, receipt of a liver transplant from a donor with DM was associated with a higher 3-year risk of graft loss vs receipt of a liver transplant from a donor without DM (HR, 2.15; 95% CI, 1.05-4.40; P =.04). In the multivariable analysis adjusted for recipient age, model for end-stage liver disease score, and retransplantation, a graft from a donor with DM “remained associated” with a higher risk for graft loss (adjusted HR, 2.21; 95% CI, 1.08-4.53; P =.03).

Limitations of this study included the small sample size. The lack of data on the duration of donor DM and type of DM medication administered was another restrictive factor. Despite the limitations, the investigators concluded that donor DM was “a risk factor for diminished outcome in the early postoperative period after liver transplantation,” and added that “the increased incidence of HAT after transplantation of livers from DM donors requires further research.”

Reference

Brüggenwirth IMA, van Reeven M, Vasiliauskaitė I, et al. Donor diabetes mellitus is a risk factor for diminished outcome after liver transplantation: a nationwide retrospective cohort study. Transpl Int. Published online October 17, 2020. doi:10.1111/tri.13770