Alterations in carbohydrate metabolism in cirrhotic patients before and after liver transplant

• This study shows a high percentage of patients with alterations in carbohydrate metabolism before liver transplant that decreases significantly after liver transplant.
• Patients showed improvement to insulin sensitivity.
• Analysis of diabetes risk factors before liver transplant shows that BMI and the degree of liver cirrhosis according to the MELD score, are the key risk factors.
• In our study, none of the studied immunosuppressants has shown to be a major diabetes risk in patients with liver graft.

AimThe main objective of this study is to demonstrate whether carbohydrate metabolism alterations identified in patients with advanced cirrhosis show any improvement after liver transplant.MethodsThe study included 86 patients who underwent liver transplant between March 2010 and February 2011. An oral glucose tolerance test was performed before the liver transplant, and 6 and 12 months after. Beta cell function and insulin resistance were also calculated, applying formulae that use basal plasma glycaemia and insulin, and plasma glycaemia and insulin during an oral glucose tolerance test. Risk factors for pre- and post-transplant diabetes were also studied. The diagnosis of diabetes was based on an OGTT.ResultsThe proportion of patients with diabetes before transplant, and at month 6 and 12 after transplant were 70.9%, 48.8% and 39.2%, respectively. Compared to baseline, at month 6 the odds ratio of having diabetes was 0.39 (IC 95% [0.21, 0.73]) and at month 12 it was 0.26 (IC 95% [0.14, 0.50]). The composite insulin sensitivity index values at 6 and 12 months were 1.72 units higher (IC 95% [0.84, 2.58]) and 1.58 units higher (IC 95% [0.68, 2.44)] than baseline. A statistically significant association was found between high MELD values and high body mass index, and risk of pre-transplant diabetes (p = 0.001 and p = 0.033, respectively). Cirrhosis aetiology did not influence the risk of diabetes.ConclusionsIn this study, we were able to ascertain that alterations in carbohydrate metabolism typical of advanced cirrhosis improve after liver transplant. This improvement is mainly due to an improvement in insulin resistance.