Donor Diabetes Mellitus Is an Independent Risk Factor for Graft Loss in HCV Positive but Not HCV Negative Liver Transplant Recipients

Abstract Purpose The incidence of breast cancer (BC) in solid organ transplant recipients is comparable to the age-matched general population. It is among the three top-most commonly occurring cancers in women after liver transplantation (LT). There is limited information on the management and outcomes of breast cancer in liver transplant recipients (LTR). We aim to evaluate the impact of LT on breast cancer surgery outcomes. Further we compare the outcomes after breast cancer surgery in LTR in transplant versus non-transplant centers. Methods National Inpatient Sample (NIS) database was accessed to identify LTR with BC. Mortality, complications, hospital charges and total length of stay (LOS) were evaluated with multivariate logistic regression testing. Weighted multivariate regression models were employed to compare outcomes at transplant and non-transplant centers. Results Ninety-nine women met inclusion criteria for LT + BC and were compared against a cohort of women with BC without LT (n = 736,527). LT + BC had lower performance status as confirmed via higher Elixhauser Comorbidity Index (20.5% vs.10.2%, p < 0001). There were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012). However, on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery (OR 1.223, p = 0.480). Cost associated with breast cancer care was significantly higher in those with LT (2.621, p < 0.001). Breast conservation surgery in LT had shorter LOS as compared to BC alone (OR 0.568, p 0.027) in all hospitals. Conclusion LT does not increase short-term mortality when undergoing breast cancer surgery. Although there were significantly more complications in the LT cohort when compared to the non-LTR (15.0% vs. 8.2%, p = 0.012), on multivariate analysis, LT was not an independent risk factor for post-operative complications following breast cancer surgery. Additionally, breast cancer treatment is more costly in LTR.

Download Full-text

Bacterial DNA in blood is an independent risk factor for readmission and change of immunosuppression at one year in liver transplant recipients.

Journal of Hepatology ◽

10.1016/s0168-8278(17)31258-8 ◽

2017 ◽

Vol 66 (1) ◽

pp. S442

Author(s):

G. Rodriguez-Laiz ◽

P. Zapater ◽

P. Melgar ◽

M. Franco ◽

C.F. Alcazar ◽

...

Keyword(s):

Risk Factor ◽

Liver Transplant ◽

Independent Risk Factor ◽

Transplant Recipients ◽

Bacterial Dna ◽

One Year ◽

Liver Transplant Recipients

Download Full-text

INTRAOPERATIVE HYPOTHERMIA IS AN INDEPENDENT RISK FACTOR FOR EARLY CYTOMEGALOVIRUS INFECTION IN LIVER TRANSPLANT RECIPIENTS

Transplantation Journal ◽

10.1097/00007890-199904270-00011 ◽

1999 ◽

Vol 67 (8) ◽

pp. 1151-1155 ◽

Cited By ~ 26

Author(s):

David L. Paterson ◽

Wolf H. Stapelfeldt ◽

Marilyn M. Wagener ◽

Timothy Gayowski ◽

Ignazio R. Marino ◽

...

Keyword(s):

Risk Factor ◽

Liver Transplant ◽

Cytomegalovirus Infection ◽

Independent Risk Factor ◽

Transplant Recipients ◽

Intraoperative Hypothermia ◽

Liver Transplant Recipients

Download Full-text

INTRAOPERATIVE HYPOTHERMIA IS AN INDEPENDENT RISK FACTOR FOR CYTOMEGALOVIRUS (CMV) INFECTION IN LIVER TRANSPLANT RECIPIENTS

Transplantation Journal ◽

10.1097/00007890-199806270-00466 ◽

1998 ◽

Vol 65 (12) ◽

pp. S114

Author(s):

David L Paterson ◽

Nina Singh ◽

Wolf Stapelfeldt ◽

Marilyn Wagener ◽

Timothy Gayowski ◽

...

Keyword(s):

Risk Factor ◽

Liver Transplant ◽

Independent Risk Factor ◽

Transplant Recipients ◽

Cmv Infection ◽

Intraoperative Hypothermia ◽

Liver Transplant Recipients

Download Full-text

Effect of Hepatitis C Viremia on Posttransplant Diabetes Mellitus in Liver Transplant Recipients

Progress in Transplantation ◽

10.1177/15269248211064879 ◽

2021 ◽

pp. 152692482110648

Author(s):

Kelsey Klein ◽

Joelle Nelson ◽

Christina Long ◽

Kermit Speeg ◽

Naim Alkhouri ◽

...

Keyword(s):

Diabetes Mellitus ◽

Hepatitis C ◽

Liver Transplant ◽

Graft Loss ◽

Transplant Recipients ◽

Direct Acting Antiviral ◽

Transplant Patients ◽

Direct Acting ◽

Liver Transplant Recipients ◽

The Impact

Introduction Posttransplant diabetes mellitus (PTDM) can increase morbidity and mortality in liver transplant recipients. Although hepatitis C seropositivity is a known risk factor for PTDM, the impact of viremia versus no viremia at time of transplant is unknown. Project Aims This program evaluation sought to compare PTDM in hepatitis C seropositive patients with and without viremia at the time of liver transplant. Design This single-center retrospective review included adult hepatitis C seropositive liver transplant recipients transplanted between January 1, 2010 to September 5, 2017 without pretransplant diabetes. Primary outcome was PTDM within 1 year. Secondary outcomes included evaluating 1-year posttransplant death-censored graft loss, mortality, and metabolic outcomes. Results Fifty-seven liver transplant recipients with hepatitis C were included, of which 53% (n = 30) were viremic at transplant. Baseline characteristics were similar between groups. Significantly more patients with pretransplant viremia developed PTDM by 1-year posttransplant compared to the patients without viremia (43% vs 11%, P = 0.01). There were no differences between groups outside of more patients with viremia requiring antihypertensives by 1-year posttransplant compared to patients without viremia (57% vs 22%, P = 0.01). Conclusion Liver transplant patients with hepatitis C viremia at transplant were more likely to develop PTDM at 1 year compared to those without pretransplant viremia. This is an added consideration when deciding the timing of direct-acting antiviral (DAA) utilization in the context of liver transplant for hepatitis C seropositive patients.

Download Full-text