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糖尿病患者肝移植的预后：一项病例对照研究
The influence of preexisting diabetes mellitus (DM) on outcome after
orthotopic liver transplantation (OLT) has not been well defined.
The objective of our study was to compare the morbidity and mortality
after OLT in 57 patients with preexisting DM (3 type I, 54 type II)
with 114 age-, sex-, and race-matched patients without DM (case controls).
The demographics were similar in both groups. Pretransplantation serum
creatinine was significantly higher in the diabetic group compared
with case controls. The incidence of the following complications was
significantly higher in the diabetic group after OLT: cardiovascular
(61.4% vs. 21.9%, P <.001), major (54.4% vs. 29.8%, P =.002) and
minor infections (29.8% vs. 7.9%, P <.0001), renal (59.7% vs. 20.2%,
P <.001), ophthalmologic (10.5% vs. 0.9%, P =.01), respiratory
(24.6% vs. 7.0%, P =.001), neurologic (31.6% vs. 7.0%, P <.001),
hematologic (19.3% vss 2.6%, P =.001), musculoskeletal (24.6% vs.
5.3%, P =.001), and malignancy (22.8% vs. 10.5%, P =.03). The duration
of hospital stay, cost of hospitalization, retransplantation, and
overall graft survival were similar. Acute rejection was seen in 50.9%
of diabetics compared with 25.4% in controls (P =.0009). One-year
(87% vs. 77%) and 2-year (81.6% vs. 70.1%) patient survival was similar,
but 5-year survival was lower in the DM group (34.4% vs. 67.7%, P
=.002). In conclusion, preexisting diabetes is associated with a significant
post-OLT morbidity and mortality, and our observations suggest that
patients with DM warrant more rigorous pre- and post-OLT evaluation.
【引自Hepatology 2001 Nov;34(5):889-95】 |
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