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Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients

This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes...

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Autores principales: Liu, Fu-Chao, Lin, Huan-Tang, Lin, Jr-Rung, Yu, Huang-Ping
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571855/
https://www.ncbi.nlm.nih.gov/pubmed/28860788
http://dx.doi.org/10.2147/TCRM.S142348
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author Liu, Fu-Chao
Lin, Huan-Tang
Lin, Jr-Rung
Yu, Huang-Ping
author_facet Liu, Fu-Chao
Lin, Huan-Tang
Lin, Jr-Rung
Yu, Huang-Ping
author_sort Liu, Fu-Chao
collection PubMed
description This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140 patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications before prescribing immunosuppressants for liver transplant recipients.
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spelling pubmed-55718552017-08-31 Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients Liu, Fu-Chao Lin, Huan-Tang Lin, Jr-Rung Yu, Huang-Ping Ther Clin Risk Manag Original Research This nationwide, population-based study aimed to clarify the effects of immunosuppressive regimens on new-onset diabetes after liver transplantation (NODALT). The National Health Insurance database of Taiwan was explored for patients who received liver transplantation without pre-transplant diabetes from 1998 to 2012. Information regarding clinical conditions and immunosuppressant utilization among these patients was analyzed statistically. Of the 2,140 patients included in our study, 189 (8.8%) developed NODALT. The pre-transplant risk factors for NODALT were identified as old age, male sex, hepatitis C, alcoholic hepatitis, and immunosuppressant use of tacrolimus (TAC). All patients used corticosteroids as a baseline immunosuppressant. The immunosuppressant regimen of cyclosporine (CsA)+TAC+mycophenolate mofetil (MMF) contributed most to NODALT (adjusted hazard ratio 7.596) in comparison with the regimens of TAC+MMF and CsA+MMF; this regimen also contributed significantly to higher post-transplant bacteremia, urinary tract infection, pneumonia, renal failure, and mortality rate. In conclusion, our analysis confirmed TAC-based immunosuppression contributes to higher NODALT incidence than CsA-based regimen, and TAC-CsA conversion due to any causes might lead to worse clinical outcomes. Clinicians should make better risk stratifications before prescribing immunosuppressants for liver transplant recipients. Dove Medical Press 2017-08-18 /pmc/articles/PMC5571855/ /pubmed/28860788 http://dx.doi.org/10.2147/TCRM.S142348 Text en © 2017 Liu et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Original Research
Liu, Fu-Chao
Lin, Huan-Tang
Lin, Jr-Rung
Yu, Huang-Ping
Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title_full Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title_fullStr Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title_full_unstemmed Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title_short Impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
title_sort impact of immunosuppressant therapy on new-onset diabetes in liver transplant recipients
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571855/
https://www.ncbi.nlm.nih.gov/pubmed/28860788
http://dx.doi.org/10.2147/TCRM.S142348
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