S1359 Post-Liver Transplant Metabolic Changes after One Year

Introduction: Elevations in HbA1c and BMI preoperatively and postoperatively are associated with post-transplant complications that impact long-term morbidity and mortality. The aim of this study is to evaluate the impact of transplant indications and demographic background on postoperative changes in HbA1c and BMI. Understanding factors associated with elevations in HbA1c and BMI can help determine at-risk patient groups. Methods: We performed an IRB-approved retrospective study. We obtained records of patients who underwent liver transplantation at Thomas Jefferson University Hospital from January 2002 to December 2020. We analyzed changes in BMI/HbA1c at transplant and one year post-transplant by age, race, gender, and indication for transplant using STATA statistical software 14.2. Results: Of the 100 liver transplant patients included in our study, 57 (63.3%) were male, and 33 (36.7%) were female. The average age was 63.26 years (61.13- 65.38, 95% CI), and the mean BMI and HbA1c at the time of transplant were 31.01 kg/m2(29.90-32.13, 95% CI) and 6.26 (5.89-6.62, 95% CI), respectively. There was no statistically significant (P >0.05) change in preoperative and one year postoperative BMI in transplant patients who had the following indications: NASH, Alcohol Cirrhosis, HCV, HBV, PSC, HCC, and cryptogenic cirrhosis. There was also no significant change in preoperative and one year postoperative BMI when stratifying patients by gender, race, and age or in preoperative and one year postoperative HbA1c when stratifying by indication for liver transplant, gender, and race. Patients < 50 years had a significantly greater one year postoperative HbA1c compared to their preoperative HbA1c (5.10 vs 6.09, p =0.048). There was no significant difference in preoperative and one year postoperative HbA1c in patients ≥50 years. (Table) Conclusion: Significant elevations in HbA1c post-transplant may predispose patients to post-transplant diabetes, which is associated with transplant dysfunction and mortality, and may cause post-transplant metabolic syndrome, which increases the risk of and complications from cardiovascular events. Our data showed that patients under the age of 50 need careful monitoring to minimize modifiable metabolic abnormalities. Determining high-risk populations for post-transplant complications is crucial to reduce long-term post-transplant morbidity and mortality. Further research is needed to elucidate additional risk factors for post-transplant complications. Table 1. - Metabolic Changes After 1 Year Liver Transplant Total Patients (%) Mean BMI (95% CI) At Transplant At 1 year after Transplant p-value Overall 90 (100) 31.01 (29.90-32.13) 30.88 (29.59-32.17) 0.16 Indication for Transplant NASH/NAFLD 27 (30.7) 33.08 (31.12-35.03) 32.30 (31.55-33.06) 0.21 Alcohol 11 (12.5) 26.19 (23.22-29.16) 25.96 (24.12-27.80) 0.45 HCV 9 (10.2) 30.81 (27.35-34.27) 31.23 (28.83-33.62) 0.36 HBV 2 (2.3) 37.2 (49.12-25.28) 34.40 (57.76-11.04) 0.13 PSC 1 (1.1) 25.8 (n/a) 26.3 (n/a) n/a HCC 3 (3.4) 29.00 (25.88-32.12) 28.53 (24.20-32.86) 0.30 Cirrhosis NOS/Cryptogenic 13 (14.8) 28.57 (25.65-31.49) 29.54 (27.89-31.19) 0.21 HCV + HCC 18 (20.5) 32.09 (29.65-34.53) 31.63 (30.47-32.79) 0.19 NASH + HCC 2 (2.3) 31.40 (19.48-43.32) 33.72 (10.36-57.08) 0.13 Alcohol + HCC 2 (2.3) 30.00 (20.45-39.55) 28.51 (9.80-47.23) 0.37 HCC=hepatocellular carcinoma, NASH= nonalcoholic steatohepatitis, HBV= Hepatitis B, HCV= Hepatitis C, PSC=primary sclerosing cholangitis.