P66 Risk factors for post-transplant diabetes mellitus in liver transplant recipients: A Systematic review and Meta-analysis

<h3>Background</h3> Post-transplant diabetes mellitus (PTDM) is one of the most common metabolic complications following liver transplant (LT) that reduces graft and recipient overall survival. An accurate and detailed understanding of PTDM related risk factors after LT is critical for improving patient outcomes and preventing PTDM incidences. Therefore, we aimed to conduct a meta-analysis to identify risk factors for the development of PTDM following a liver transplant. <h3>Methods</h3> Two reviewers independently searched three electronic databases Cochrane Central, Scopus, and PubMed until May 2022 for case-control studies that investigated risk factors of PTDM diagnosed in adult liver transplant recipients. The methodological quality of the included studies was assessed with Newcastle-Ottawa Scale (NOS) tool. Meta-analysis was performed using random-effects models to calculate odds ratios (OR) for dichotomous outcomes and weighted mean differences (WMD) for continuous data. A p-value &lt;0.05 was considered to be statistically significant. Statistical analyses were conducted using Stata version 17.0. <h3>Results</h3> 31 studies with 20,536 participants including 5131 with PTDM after liver transplantation, were included in the meta-analysis. Our pooled analysis shows that development of PTDM after LT is significantly associated with recipient age (WMD: 3.63, 95% CI [2.20, 5.07]; p &lt; 0.001), recipient body mass index (WMD: 1.37, 95% CI [0.91, 1.83]; p &lt; 0.001), male gender (OR: 1.55, 95% CI [1.35, 1.79]; p &lt; 0.001), family history of diabetes mellitus (OR: 2.04, 95% CI [1.46, 2.63]; p =0.02), impaired fasting glucose (OR: 1.66, 95% CI [1.24, 2.08]; p =0.02), hepatitis C infection (OR: 2.05, 95% CI [1.80, 2.30]; p &lt;0.001), alcoholic liver disease (OR: 1.31, 95% CI [1.05, 1.57]; p =0.04), cytomegalovirus infection (OR: 2.80, 95% CI [ 2.29, 3.31]; p &lt;0.001), history of hypertension (OR: 2.11, 95% CI [1.41, 2.80]; p =0.04) and acute rejection (OR: 1.44, 95% CI [1.23, 1.64]; p &lt;0.001). However, hepatitis B infection and immunosuppressants such as tacrolimus, cyclosporine, sirolimus, and steroids were not associated with PTDM (p&gt;0.05). <h3>Conclusions</h3> This study has identified multiple risk factors such as older age, male gender, high BMI, pre-transplant impaired fasting glucose, family history of diabetes, history of hypertension, alcoholic liver disease, cytomegalovirus and hepatitis C infection to be independently associated with an increased risk of PTDM after liver transplant. Some of the identified factors are potentially modifiable. Therefore, large epidemiological studies are still needed for further investigation.

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