Living with a transplanted liver is associated with diabetes

The reported prevalence of post-transplantation diabetes in liver transplant recipients ranges from 9% to 31%. However, no previous study has investigated if living with a transplanted liver is associated with increased odds of diabetes, when adjusting for several known confounders. In this cross-sectional study, we included 490 liver transplant recipients at least 3 months after transplantation from the Danish Comorbidity in Liver Transplantation study (DACOLT), and 1,960 age- and sex-matched controls from the Copenhagen General Population Study (CGPS). Diabetes was defined as HbA1c ≥ 48 mmol/mol, random plasma glucose ≥ 11.1 mmol/L, self-reported diabetes and/or antidiabetic treatment. In a multivariable model, living with a transplanted liver was associated with an 8.6-fold (95% CI 6.2, 12.1; P < 0.001) increased odds of diabetes. Among liver transplant recipients and controls receiving antidiabetic treatment, 35.4% (n = 29) and 44.6% (n = 25), respectively, exceeded the HbA1c treatment threshold of 52 mmol/mol, P-value = 0.36. Within liver transplant recipients, risk factors associated with post-transplantation diabetes included previous rejection (OR 2.4; 95% CI 1.1, 5.1; P = 0.03). In conclusion, living with a transplanted liver was associated with nine-fold increased odds of diabetes. Greater clinical awareness of the diagnosis and management of post-transplantation diabetes in liver transplant recipients is clinically important and may improve patient outcomes.