학술논문
Impact of Pretransplant Diabetes on Outcomes After Liver Transplantation: An Updated Meta-analysis With Systematic Review
Document Type
Academic Journal
Author
Tang, Ansel Shao Pin; Tan, Caitlyn; Lim, Wen Hui; Ng, Cheng Han; Tan, Darren Jun Hao; Zeng, Rebecca; Xiao, Jieling; Ong, Elden Yen Hng; Cho, Elina; Chung, Charlotte; Lim, Wei Shyann; Chee, Douglas; Nah, Benjamin; Tseng, Michael; Syn, Nicholas; Bonney, Glenn; Liu, Ken; Huang, Daniel Q.; Muthiah, Mark; Siddiqui, Mohammad Shadab; Tan, Eunice X.X.
Source
Transplantation. May 01, 2024 108(5):1157-1165
Subject
Language
English
ISSN
0041-1337
Abstract
BACKGROUND.: Preliver transplant diabetes mellitus (pre-LT DM) is a common comorbidity in LT recipients associated with poorer post-transplant survival. However, its relationship with other important outcomes, including cardiovascular and renal outcomes, remains unclear. This meta-analysis aims to provide an updated analysis of the impact of pre-LT DM on key post-LT outcomes. METHODS.: A search was conducted in Medline and Embase databases for articles comparing the post-transplant outcomes between patients with and without pre-LT DM. Pairwise analysis using random effects with hazard ratios (HRs) was used to assess the longitudinal post-LT impacts of pre-LT DM. In the absence of HR, pooled odds ratios analysis was conducted for secondary outcomes. RESULTS.: Forty-two studies involving 77,615 LT recipients were included in this analysis. The pooled prevalence of pre-LT DM amongst LT recipients was 24.79%. Pre-LT DM was associated with significantly lower overall survival (HR, 0.65; 95% confidence interval, 0.52-0.81; P<0.01) and significantly increased cardiovascular disease-related mortality (HR, 1.78; 95% confidence interval, 1.11-2.85; P=0.03). Meta-regression of other patient characteristics identified Asian ethnicity and hypertension to be significant predictors of worse overall survival, whereas African-American ethnicity was associated with significantly improved overall survival in patients with pre-LT DM. Further analysis of secondary outcomes revealed pre-LT DM to be a significant predictor of post-LT cardiovascular events and end-stage renal disease. CONCLUSIONS.: The present study illustrates the impact of pre-LT DM on post-LT survival, and cardiovascular and renal outcomes and provides a sound basis for revision of preoperative management of pre-LT DM.