Chronic hepatitis C virus infection and post-liver transplantation diabetes mellitus

Figure 1 Possible mechanism underlying the development of PTDM in HCV infection (at least four mechanisms contribute to exacerbation of insulin resistance). ⑴ Chronic activation of TNF-α, which plays a key role not only in the production of and response to HCV itself, but also in the development of insulin resistance. Additional factors for developing PTDM in HCV-infected patients, including obesity, black ethnicity, and aging, are known to be associated with increased TNF-α independent mechanisms; ⑵ the increased clearance of insulin that occurs in post-transplant recipients thus creates a reactive hyperinsulinemic medium, and that in turn might enhance insulin resistance; ⑶ a bi-directional relationship between liver disease and diabetes is possible, as both insulin resistance and PTDM can adversely affect HCV liver disease; ⑷ directly diabetogenic effect of immunosuppressive therapy on pancreatic b cell.