The severity of hepatitis C recurrence post liver transplantation correlates with poorly controlled

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The severity of hepatitis C recurrence post
liver transplantation correlates with poorly
controlled diabetes mellitus.
Gordon Liss July 24, 2006
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Contributors

• Advisor Kirti Shetty, MD
• Stats Muhannad Hafi, MD
• New Recruit Yasmeen Karim, MD

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Background

• HCV cirrhosis is most common indication for OLT
  (gt1/3)
• Incidence is decreasing
• Prevalence of chronic infection expected to peak
  in 2010 increase by 2/3
• Meaningful post-OLT f/u limited to 3-5 years

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Background

• Recurrence of Hep C is substantial source of MM,
  graft loss
• HCV infected recipient may have worse survival
• 10 recurrence by post-op year 5
• Epidemiological and case-control data suggests an
  association between HCV recurrence and
  post-transplant diabetes mellitus (DM).

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Background

• Factors linked to recurrence
• Viral
• Viral load gt 1mEq/ml, genotype 1 and 4, of
  quasispecies, pre-OLT IFN failure
• Host
• Age, non-white race, HLA matching, lack of CD4
  responsiveness
• Donor
• Age, fat content, ischemic time, living donor
• Clinical
• Steroid exposure, rejection, CMV

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Our Study

• Retrospective
• Chart Review
• OLT 1998 to present
• Age, sex, BMI, race, date of first recurrence,
  recurrences, AST, ALT, INR, Bili, Albumin, Cr,
  BG, Path, rejections, steroid duration,
  immunosupression, age of donor, HCV genotype/
  viral load, HgA1c

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Our Goals

• (1) To determine the risk factors for the
  development of post-transplant DM in HCV positive
  LT recipients.
• (2) To assess the relationship between severity
  of DM (as determined by peak blood glucose
  level) and rate of HCV recurrence.
• (3) To determine whether poorly controlled DM
  correlated with severity of HCV recurrence as
  assessed by peak bilirubin level.

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Our Results

• Number of observations 45
• Age at treatment mean age 51, min 39, max 67
• Peak bilirubin mean bili 5.51, min 0.4, max 28.8
• Peak blood sugar mean 246.65, min 81, max 519
• Steroid duration in days mean 295.4, min 21, max
  1580
• Rejections 55 with no rejection, 27 with one
  rejection, 16 with two rejections, and 2 with
  three rejections.
• Diabetes 64 non-diabetic, 27 diabetic, 9 NA

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Conclusion

• 1. Post-OLT DM is associated with duration of
  steroid therapy, and episodes of ACR.
• 2. Poorly controlled DM correlates with the
  severity of HCV recurrence as measured by serum
  bilirubin levels. (P0.01)
• 3. Further prospective studies are required to
  further define the relationship between these two
  important clinical entities.