Dynamics of glucose metabolism after liver transplantation: Prediabetes as a window of opportunity for patient survival and long‐term kidney function

Posttransplantation diabetes mellitus (PTDM) is a relevant complication
following liver transplantation with profound impact on morbidity and
mortality. To date, little is known about the evolution and dynamics of
glucose metabolism and the impact of prediabetes in long-term follow-up.
To address this issue, all consecutive adult liver transplant recipients
(n=429) from a European university hospital transplant center between 2007
and 2017 were analyzed retrospectively. In patients without pre-existing
diabetes (n=327), we conducted a longitudinal characterization of glucose
metabolism. Median follow-up was 37 [9-64, IQR] months. Median prevalence
of prediabetes was 39 [37-39]% and of PTDM 21 [17-22]%. Throughout
follow-up, intra-individual glucose regulation of patients was highly
variable, continuously fluctuating between different states of glucose
metabolism (normal glucose tolerance, prediabetes, PTDM). Whereas overall
survival and long-term kidney function of patients with PTDM were
significantly lower than that of patients with normal glucose metabolism,
prediabetes was not associated with adverse outcome. This study provides
new insight into the dynamics and impact of glucose metabolism after liver
transplantation. Unlike PTDM, prediabetes is not associated with adverse
outcome, providing a window of opportunity for targeted intervention. The
results underline the need for constant screening and intervention in
post-transplant care of liver allograft recipients.