Endocrine Abstracts

New-onset diabetes after transplantation (NODAT) is a serious complication after a solid organ transplantation. It has been reported to occur in 4% to 25% of renal transplant recipients, 2.5% to 25% of liver transplant recipients, 40% to 60% of hepatitis C virus (HCV) infection and 2% to 53% of all solid organ transplantations. The diagnosis is performed using unmodified criteria for diagnosing diabetes in the general population and risk factors are the commonly recognized factors for developing diabetes: obesity, diabetes family history, dyslipidemias, etc. Recent studies suggest that hyperglycemia is associated with an increased risk of hepatitis C virus-related fibrosis development and glycemic control may reduce the risk and severity of recurrence. In addition, it is well known that liver function plays an essential role in glycemic metabolism. That’s why it is important to be aware of this bidirectional relation to decrease morbidity and mortality and preserve quality of life. In this report, we describe a NODAT case after liver transplantation whose hyperglycemic state could have preceded a worsening of HCV infection. A 42 years-old woman affected by HCV infection and cirrhosis undergo liver transplantation. After the surgery, she started a posttransplant immunosuppressive treatment (prednisone). Initially her glycemic control was excellent, but five years later she asked her doctor complaining of polyuria and polidipsia. Her endocrinologist performed a blood test that shown a high glycosylated hemoglobin (HbA1c) level (11.6%) and quickly started basal insulin therapy. The study showed a normal C-peptide and negative GAD antibodies, her weight was 70 kg and she had not another diabetes risk factors. Throughout the following years, because of suboptimal control, it was necessary to add a short-acting insulin in the mayor meal (basal-plus insulin regimen) and after one year it was necessary to add insulin also in the other meals (basal-bolus regimen). HbA1c levels decreased to 7%, but some months later the patient suffered a HCV infection recurrence with stage 4 fibrosis. The Digestive System Unit quickly started Sirolimus, a direct-acting antiviral agent. Then, the patient started to lose weight and a year afterthat she had lost 12 kg. Some months later, the patient achieved sutained virological response and insulin sensitivity improved, allowing to decrease insulin therapy until it was withdrawn. In the long run, HCV infection can lead to cirrhosis, hepatocarcinoma and death in some patients. Physicians should be aware of the importance of NODAT and addressing insulin resistance to improve disease prognosis.