Risk for developing diabetes after undergoing kidney transplantation increased more than threefold for adults with presurgical hepatitis C infection vs. those with hepatitis B and those without infection, according to study results from researchers in China.
, MD, chief physician in the departments of endocrinology and metabolism at Zhongshan Hospital, Fudan University, Shanghai, and colleagues conducted a retrospective cohort study of 557 kidney transplant recipients from 1993 to 2014 at Zhongshan Hospital. Patients were divided into four groups: those infected with HCV prior to transplantation (n = 34), those with HBV (n = 46), those with HBV and HCV (n = 7), and those uninfected (n = 470). Each participant underwent outpatient monitoring every month for 1 year after transplantation. Visits were made every 2 to 3 months after the first year. Diagnosis of diabetes was not made until at least 3 months after transplantation to avoid potentially confounding factors from immediate surgery side effects.
Of the 557 participants, 120 were diagnosed with diabetes during the observation period. Time from transplantation to diabetes diagnosis was a median of 7.53 years. The researchers discovered more participants in the HCV group developed diabetes (55.88%) than the other groups (P < .001), while those with both HCV and HBV had an even higher rate (71.43%).
“The underlying mechanisms by which HCV infection is associated with increased risk of [new-onset diabetes after transplantation] has not been fully elucidated, and both increased insulin resistance and reduced insulin secretion are implicated in the pathogenesis of [new-onset diabetes after transplantation],” the researchers wrote. “Insulin resistance was believed to play a central role in the association between HCV infection and [new-onset diabetes after transplantation] through several pathways, all of which would lead to the degradation or down-regulated expression of the insulin receptor substrate, and thus, interrupting the metabolic responses to insulin.”
Multivariate analysis revealed that transplant recipients with HCVwere slightly more than three times more likely to develop diabetes (aHR = 3.03; 95% CI, 1.77-5.18) than those in the HBV and uninfected groups. Participants with HBV had a non-significant 1.8-fold increase in risk for diabetes development (95% CI, 0.94-3.44).
“Our study reported a strong association between preoperative HCV infection and [new-onset diabetes after transplantation] development in Chinese [kidney transplant recipients], independent of various confounders. HBV infection and co-infection do not independently increase the risk of [new-onset diabetes after transplantation],” the researchers wrote. “Therefore, it is necessary that [kidney transplant recipients] with previous HCV infection receive rigorous monitoring and screening, so that those with increased risk of [new-onset diabetes after transplantation] can receive effective diagnosis and timely intervention to improve their long-term survival.” – by Phil Neuffer
Disclosures: The authors report no relevant financial disclosures.