Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2015; 21(20): 6329-6340
Published online May 28, 2015. doi: 10.3748/wjg.v21.i20.6329
Risk factors for new onset diabetes mellitus after liver transplantation: A meta-analysis
Da-Wei Li, Tian-Fei Lu, Xiang-Wei Hua, Hui-Juan Dai, Xiao-Lan Cui, Jian-Jian Zhang, Qiang Xia
Da-Wei Li, Tian-Fei Lu, Xiang-Wei Hua, Hui-Juan Dai, Xiao-Lan Cui, Jian-Jian Zhang, Qiang Xia, Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Author contributions: Li DW, Lu TF and Hua XW contributed equally to this work; Xia Q and Li DW proposed the study; Li DW, Lu TF and Hua XW performed the literature search and carried out statistical analyses; Dai HJ, Cui XL and Zhang JJ performed data extraction; Hua XW analyzed the data; Li DW and Lu TF wrote the first draft; all authors contributed to the design and interpretation of the study and to further drafts; Xia Q is the guarantor and all authors read and approved the final manuscript.
Supported by New Hundred Talents Program of Shanghai Municipal Health and Family Planning Commission, No. XBR2011029.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qiang Xia, MD, PhD, Professor, Department of Liver Surgery and Liver Transplantation Center, Renji Hospital, School of Medicine, Shanghai Jiaotong University, No. 1630 Dongfang Road, Shanghai 200127, China. xiaqiang@shsmu.edu.cn
Telephone: +86-21-68383775 Fax: +86-21-58737232
Received: August 23, 2014
Peer-review started: August 23, 2014
First decision: September 23, 2014
Revised: October 16, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: May 28, 2015
Processing time: 280 Days and 12.8 Hours
Abstract

AIM: To determine the risk factors for new-onset diabetes mellitus (NODM) after liver transplantation by conducting a systematic review and meta-analysis.

METHODS: We electronically searched the databases of MEDLINE, EMBASE and the Cochrane Library from January 1980 to December 2013 to identify relevant studies reporting risk factors for NODM after liver transplantation. Two authors independently assessed the trials for inclusion and extracted the data. Discrepancies were resolved in consultation with a third reviewer. All statistical analyses were performed with the RevMan5.0 software (The Cochrane Collaboration, Oxford, United Kingdom). Pooled odds ratios (OR) or weighted mean differences (WMD) with 95% confidence intervals (CIs) were calculated using either a fixed effects or a random effects model, based on the presence (I2 < 50%) or absence (I2 > 50%) of significant heterogeneity.

RESULTS: Twenty studies with 4580 patients were included in the meta-analysis, all of which were retrospective. The meta-analysis identified the following significant risk factors: hepatitis C virus (HCV) infection (OR = 2.68; 95%CI: 1.92-3.72); a family history of diabetes (OR = 1.69, 95%CI: 1.09-2.63, P < 0.00001); male gender (OR = 1.53; 95%CI: 1.24-1.90; P < 0.0001); impaired fasting glucose (IFG; OR = 3.27; 95%CI: 1.84-5.81; P < 0.0001); a family history of diabetes (OR = 1.69; 95%CI: 1.09-2.63; P = 0.02); use of tacrolimus (OR = 1.34; 95%CI: 1.03-1.76; P = 0.03) and body mass index (BMI)(WMD = 1.19, 95%CI: 0.69-1.68, P < 0.00001). Other factors, such as hepatitis B virus infection and alcoholism, were not found to be associated with the incidence of NODM.

CONCLUSION: The study showed that HCV infection, IFG, a family history of diabetes, male gender, tacrolimus and BMI are risk factors for NODM after liver transplantation.

Keywords: Diabetes mellitus; Meta-analysis; Risk factor; Liver transplantation; Hepatitis C virus

Core tip: New-onset diabetes mellitus (NODM) is a serious complication of liver transplantation (LT) that negatively affects patient and graft survival. However, the risk factors for NODM after LT have not been well elucidated. It has been reported that many factors are involved in the development of NODM. This meta-analysis demonstrated that hepatitis C virus infection, impaired fasting glucose, a family history of diabetes, male gender, tacrolimus and body mass index are risk factors for NODM after liver transplantation.