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2017 ; 3
(9
): e208
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Liver Enzymes and the Development of Posttransplantation Diabetes Mellitus in
Renal Transplant Recipients
#MMPMID28894795
Klaassen G
; Corpeleijn E
; Deetman NPE
; Navis GJ
; Bakker SJL
; Zelle DM
Transplant Direct
2017[Sep]; 3
(9
): e208
PMID28894795
show ga
BACKGROUND: Posttransplantation diabetes mellitus (PTDM) is common in renal
transplant recipients (RTR), increasing the risk of graft failure, cardiovascular
disease, and mortality. Early detection of a high risk for PTDM is warranted.
Because liver function and liver fat are involved, we investigated whether serum
liver markers are associated with future PTDM in RTR. METHODS: Between 2001 and
2003, 606 RTR with a functioning allograft beyond the first year after
transplantation were included of which 500 participants (56% men; age, 50 ± 12
years) were free of diabetes at baseline and had liver enzyme values (1 missing)
available. Serum concentrations of alanine aminotransferase (ALT), gamma-glutamyl
transferase (GGT), alkaline phosphatase were measured at baseline at 6.0
(6.2-11.5) years posttransplantation. PTDM cases were recorded until April 2012.
RESULTS: During median follow-up for 9.6 years (interquartile range [IQR],
6.2-10.2) beyond baseline, 76 (15.2%) patients developed PTDM. Comparing the
highest to the lower tertiles, higher liver enzyme activities were significantly
related to incident PTDM for ALT (hazard ratio [HR], 2.22; IQR, 1.42-3.48), for
GGT (HR, 2.93; IQR, 1.87-4.61), and for alkaline phosphatase (HR, 1.78; IQR,
1.13-2.80). The associations of ALT and GGT with development of PTDM were
independent of potential confounders and risk factors, including age, sex, renal
function, medication use, lifestyle factors, adiposity, presence of the metabolic
syndrome, fasting glucose, HbA1c, proinsulin, and cytomegalovirus status.
CONCLUSIONS: Markers for liver function and liver fat in the subclinical range
are potential markers for future PTDM, independent of other known risk factors.
This may allow for early detection and management of PTDM development.