B. A. Yerokun1, M. S. Mulvihill1, R. P. Davis1, M. G. Hartwig1, A. S. Barbas1 1Duke University Medical Center,Department Of Surgery,Durham, NC, USA
Introduction:
While the association between donor diabetes mellitus and liver transplant recipient outcomes is well described, limited data exist on the effect of donor glyclated hemoglobin (Hgb A1c) and recipient outcomes after liver transplantation. The objective of the analysis was to evaluate liver transplant recipient outcomes associated with donor Hgb A1c levels in non-diabetic donors in the United States. We tested the hypothesis that the use of allografts from non-diabetic donors with an elevated donor Hgb A1c would be associated with decreased allograft and overall survival.
Methods:
The Scientific Registry of Transplant Recipients was used to identify adult patients who underwent liver transplantation (2010-2015). Liver transplant recipients were stratified into two groups based of the Hgb A1c level of the donor: Hgb A1c <6.5 (euglycemic) vs ≥6.5 (hyperglycemic). Recipients of donors with a missing Hgb A1c were excluded. Propensity score matching (10:1) was used to adjust for donor age, donor gender, donor ethnicity, donor serum creatinine, extended criteria allografts, recipient age, recipient gender, recipient ethnicity, recipient MELD score. Kaplan-Meier analysis was used to assess overall survival.
Results:
A total of 10491 liver transplant recipients were included: 10156 (96.8%) received euglycemic allografts & 335 (3.2%) received hyperglycemic allografts. Hyperglycemic donors were older (49 v 36), had a higher BMI (29.8 v 26.2), had a higher serum creatinine (1.3 v 1.0 mg/dL), and were more likely to be an extended criteria donor (35.8 v 14.4%). Recipients of hyperglycemic allografts were more often female (74 v 66%) and had a lower MELD score at time of transplantation (20 v 23). Recipients of hyperglycemic and euglycemic allografts were similar in age, BMI, diabetes, and time on waitlist. After adjustment, overall survival was not statistically different between the two groups (p=0.065), but allograft survival was significantly increased in the recipients of euglycemic allografts (p=0.035).
Conclusion:
In this nationally representative study of liver transplant recipients, patients who received hyperglycemic allografts had decreased allograft survival compared to those patients who received euglycemic allografts. This analysis demonstrates potential utility in the measurement of Hgb A1c for assessment of liver allografts.
