TY - JOUR
T1 - Diabetes, hypertension and hyperlipidemia
T2 - Prevalence over time and impact on long-term survival after liver transplantation
AU - Parekh, J.
AU - Corley, D. A.
AU - Feng, S.
PY - 2012/8
Y1 - 2012/8
N2 - With increasing short-term survival, the transplant community has turned its focus to delineating the impact of medical comorbidities on long-term outcomes. Unfortunately, conditions such as diabetes, hypertension and hyperlipidemia are difficult to track and often managed outside of the transplant center by primary care providers. We collaborated with Kaiser Permanente Northern California to create a database of 598 liver transplant recipients, which incorporates diagnostic codes along with laboratory and pharmacy data. Specifically, we determined the prevalence of diabetes, hypertension and hyperlipidemia both before and after transplant and evaluated the influence of disease duration as a time-dependent covariate on posttransplant survival. The prevalence of these comorbidities increased steadily from the time of transplant to 7 years after transplant. The estimated risk for all-cause mortality (hazard ratio = 1.07 per year increment, 95% CI 1.01-1.13, p < 0.02) and mortality secondary to cardiovascular events, infection/multisystem organ failure and allograft failure (hazard ratio = 1.08 per year increment, 95% CI 1.00-1.16, p = 0.05) increased for each additional year of diabetes. No associations were found for duration of hypertension and hyperlipidemia. Greater attention to management of diabetes may mitigate its negative impact on long-term survival in liver transplant recipients. A unique integration of longitudinal data from a transplant center and integrated healthcare delivery organization shows that the duration of diabetes, but not hypertension or hyperlipidemia, is a significant predictor of long-term mortality for adult liver transplant recipients.
AB - With increasing short-term survival, the transplant community has turned its focus to delineating the impact of medical comorbidities on long-term outcomes. Unfortunately, conditions such as diabetes, hypertension and hyperlipidemia are difficult to track and often managed outside of the transplant center by primary care providers. We collaborated with Kaiser Permanente Northern California to create a database of 598 liver transplant recipients, which incorporates diagnostic codes along with laboratory and pharmacy data. Specifically, we determined the prevalence of diabetes, hypertension and hyperlipidemia both before and after transplant and evaluated the influence of disease duration as a time-dependent covariate on posttransplant survival. The prevalence of these comorbidities increased steadily from the time of transplant to 7 years after transplant. The estimated risk for all-cause mortality (hazard ratio = 1.07 per year increment, 95% CI 1.01-1.13, p < 0.02) and mortality secondary to cardiovascular events, infection/multisystem organ failure and allograft failure (hazard ratio = 1.08 per year increment, 95% CI 1.00-1.16, p = 0.05) increased for each additional year of diabetes. No associations were found for duration of hypertension and hyperlipidemia. Greater attention to management of diabetes may mitigate its negative impact on long-term survival in liver transplant recipients. A unique integration of longitudinal data from a transplant center and integrated healthcare delivery organization shows that the duration of diabetes, but not hypertension or hyperlipidemia, is a significant predictor of long-term mortality for adult liver transplant recipients.
KW - Liver transplantation
KW - metabolic disorders
KW - mortality
UR - http://www.scopus.com/inward/record.url?scp=84864433273&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84864433273&partnerID=8YFLogxK
U2 - 10.1111/j.1600-6143.2012.04077.x
DO - 10.1111/j.1600-6143.2012.04077.x
M3 - Article
C2 - 22548965
AN - SCOPUS:84864433273
SN - 1600-6135
VL - 12
SP - 2181
EP - 2187
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -