Risk of de novo post-transplant type 2 diabetes in patients undergoing liver transplant for non-alcoholic steatohepatitis

BACKGROUND Non-alcoholic steatohepatitis (NASH) is often seen together with components of metabolic syndrome. The aim of this study was to assess the risk of de novo post-transplant type 2 diabetes (DM) in liver transplant recipients with NASH. METHODS All adult patients from the Scientific Registry of Transplant Recipients (2003-2012) transplanted for NASH or cryptogenic cirrhosis (the NASH cohort) without pre-transplant DM were included in this retrospective cross-sectional study. RESULTS Total 2,916 NASH subjects and 14,268 controls with non-HCV related cirrhosis or hepatocellular carcinoma were included. Patients with NASH were, on average, 6 years older, more likely female and overweight/obese. By 5 years post-transplant, 39.8% NASH vs. 27.0% controls developed at least one onset of de novo DM; this was observed starting 6 months post-transplant: 22.9% vs. 16.7% (relative risk 1.38). Later in follow-up, the relative risk of de novo DM was also higher in NASH: 1.46 by 3 years, 1.47 by 5 years (all p < 0.0001). After exclusion of DM that resolved after the first year, long-term DM remained higher in the NASH cohort: 7.6% vs. 4.3%, p < 0.0001. In multivariate analysis, after adjustment for confounders including the use of immunosuppressants, having NASH was independently associated with development of de novo post-transplant DM: adjusted hazard ratio (95% CI) = 1.29 (1.18-1.42), p < 0.0001. CONCLUSIONS Liver transplant recipients with NASH have a higher risk of de novo post-transplant DM. This suggests the presence of an underlying metabolic disorder beyond fatty liver that may be causative for both NASH and type 2 diabetes.