Diabetes Metab J.  2024 Jan;48(1):146-156. 10.4093/dmj.2022.0100.

Association of Muscle Mass Loss with Diabetes Development in Liver Transplantation Recipients

• Lee S
• Lee M
• Kim YE
• Kim HK
• Lee SJ
• Kim J
• Yang Y
• Kim CH
• Lee H
• Joo DJ
• Kim MS
• Kang ES

• KMID: 2551270
• DOI: http://doi.org/10.4093/dmj.2022.0100

Abstract

Background
Post-transplant diabetes mellitus (PTDM) is one of the most significant complications after transplantation. Patients with end-stage liver diseases requiring transplantation are prone to sarcopenia, but the association between sarcopenia and PTDM remains to be elucidated. We aimed to investigate the effect of postoperative muscle mass loss on PTDM development.
Methods
A total of 500 patients who underwent liver transplantation at a tertiary care hospital between 2005 and 2020 were included. Skeletal muscle area at the level of the L3–L5 vertebrae was measured using computed tomography scans performed before and 1 year after the transplantation. The associations between the change in the muscle area after the transplantation and the incidence of PTDM was investigated using a Cox proportional hazard model.
Results
During the follow-up period (median, 4.9 years), PTDM occurred in 165 patients (33%). The muscle mass loss was greater in patients who developed PTDM than in those without PTDM. Muscle depletion significantly increased risk of developing PTDM after adjustment for other confounding factors (hazard ratio, 1.50; 95% confidence interval, 1.23 to 1.84; P=0.001). Of the 357 subjects who had muscle mass loss, 124 (34.7%) developed PTDM, whereas of the 143 patients in the muscle mass maintenance group, 41 (28.7%) developed PTDM. The cumulative incidence of PTDM was significantly higher in patients with muscle loss than in patients without muscle loss (P=0.034).
Conclusion
Muscle depletion after liver transplantation is associated with increased risk of PTDM development.

Keyword

Diabetes mellitus; Muscle, skeletal; Liver transplantation; Sarcopenia

Figure

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  Fig. 1. Forest plots of hazard ratios (HRs) for post-transplant diabetes mellitus (PTDM) associated with muscle mass loss in the subgroup analysis. Subgroup analysis was performed according to age, sex, body mass index (BMI), fasting blood glucose, Model for End-stage Liver Disease (MELD) score, hypomagnesemia, hepatitis C virus (HCV) infection, cytomegalovirus (CMV) disease, and immunosuppressive agents. The association between muscle mass loss and PTDM development did not show heterogeneity across subgroups. CI, confidence interval; CNI, calcineurin inhibitor; MMF, mycophenolate mofetil; mTORi, mammalian target of rapamycin inhibitor.

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  Fig. 2. Receiver operating characteristic (ROC) curve analysis with variables for post-transplant diabetes mellitus (PTDM) development. ROC curve of the two models. Model 1 (indicated by a dotted line) represents the ROC curve by risk factors associated with PTDM including age, sex, body mass index, Model for End-stage Liver Disease score, fasting blood glucose, hypomagnesemia, hepatitis C virus infection, cytomegalovirus disease, and immunosuppressive agents. The solid line ROC curve represents model 1 plus ∆muscle area. The area under the ROC curve (AUC) of model 1 and model 1+ ∆muscle area was 0.63 (95% confidence interval [CI], 0.57 to 0.69) and 0.71 (95% CI, 0.65 to 0.76), respectively.

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  Fig. 3. Kaplan-Meier survival curve for post-transplant diabetes mellitus (PTDM)-free survival stratified by ∆muscle area. HR, hazard ratio.

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