Endocrine Abstracts

Introduction: Diabetes mellitus (DM) is a very common complication of cirrhosis (prevalence: 20–60%), primary due to increased hepatic insulin-resistance (IR). After liver transplantation (LT), DM recovers in 67% of cases, while 33% of patients remain diabetic because of a concomitant decreased beta cell function. The roles played by pre-transplant factors determining changes in glucose tolerance after LT are imperfectly known.

Aim of the study: To highlight any factors that predict increased risk of persistence of post-transplant glucose homeostasis alterations in diabetic cirrhotic patients undergoing LT.

Materials and methods: 42 patients with liver cirrhosis, 31M/11F, age 53±9.9 years, underwent a metabolic and anthropometric evaluation, they underwent a bioelectrical impedance analysis (BIA) and an oral glucose tolerance test (OGTT) was performed to diagnose diabetes, before and 6 months after LT. Depending on OGTT results, patients were classified as Non Diabetic (ND) patients, who remain euglycaemic before and after LT, Diabetic (D) patients, who didn’t recover from diabetes after LT, or Regressors (R), who were diabetic and returned to euglycaemia after LT. No euglycaemic cirrhotic patients became diabetic after LT, so this group was not considered. IR was assessed with HOMA index, body fat was quantified with BIA (being BMI and waist circumference unreliable in cirrhotic patients because of the presence of ascites).

Results: Depending on this classification, our population was composed by 22 ND, 13 D and seven R patients. HOMA levels before LT were higher in D patients if compared to ND and R (7.7±1.7 vs 3.1±0.6 and 3.7±1.8 respectively, P<0.05). Moreover, R showed a significant decrease in body fat, if compared to D patients (−13.3±9% vs 1.5±0.2%, P<0.05).

Conclusions: In diabetic cirrhotic patients undergoing LT, higher HOMA levels and failed decrease in body fat after LT can be considered unfavourable predictors of recovering from diabetes after transplantation.