Pre-existing diabetes and risks of morbidity and mortality after liver transplantation: A nationwide database study in an Asian population

•DM was associated with elevated 90-day risk of post-LTx stroke.•DM cohort did not exhibit higher risks of septicemia, pneumonia, and wound infection.•DM patients with renal manifestations were high risk of postoperative mortality.

BackgroundWhether diabetes mellitus (DM) is associated with a higher risk of perioperative mortality and mortality after liver transplantation (LTx) remains unclear.MethodsWe compared the risk of postoperative mortality and morbidity in DM and non-DM patients undergoing LTx. We enrolled 558 DM patients who underwent LTx from 2000 to 2010.ResultsDM was associated with elevated 90-day risk of post-LTx stroke. Otherwise, the DM cohort did not exhibit significantly higher risks of postoperative morbidities, such as septicemia, pneumonia, and wound infection, than the non-DM cohort. Cox proportional hazards regression model showed that patients with DM with coexisting renal manifestations were at a significantly high risk of 30-day and 90-day postoperative mortality. Further comorbidity stratification analysis showed that DM cohort exhibited higher risk of mortality than the non-DM cohort if the patients had liver cancer, or did not have hypertension, ischemic heart disease, and chronic obstructive pulmonary disease.ConclusionDM is associated with elevated risk of 90-day post-LTx. Moreover, DM patients with coexisting renal manifestations exhibited an increased postoperative risk of mortality after LTx.