*Purpose: Compare incidence of post-transplant diabetes mellitus (PTDM) in hepatitis C virus (HCV) patients with and without viremia at the time of orthotopic liver transplantation (OLT).

*Methods: This single-center retrospective review included adult HCV-infected OLT recipients transplanted between 1/1/2010-9/5/2017 without a pre-transplant diagnosis of diabetes. Primary outcome was PTDM incidence within 1 year of transplant, defined as any of the following: > 2 fasting blood glucoses (BG) of > 126 mg/dL, random BG > 200 mg/dL, 2-hour BG > 200 mg/dL after OGTT, HgbA1c > 6.5%, new diabetes diagnosis, or addition of anti-diabetic medications. Baseline characteristics were assessed in a univariate analysis. Variables with a p-value of < 0.1 were included in a multivariate logistic regression analysis to identify independent predictors of PTDM.

*Results: Fifty-seven OLT recipients with HCV were included, of which 53% (n=30) were actively viremic at transplant. Baseline characteristics were similar between groups, with the exception of a lower incidence of pre-transplant hypertension and direct-acting antiviral agent use in the actively viremic group. Univariate analysis identified active viremia (p=0.0086), male gender (p=0.064), and higher biological MELD score (p=0.0287) to be included in multivariate analysis. Biological MELD score and active viremia were identified on multivariate analysis to be independently associated with PTDM (Table 1). Relative risk for PTDM in patients with viremia compared to those without was 3.9 (95% CI 1.3-12.2).

*Conclusions: OLT patients with HCV active viremia or higher biological MELD score at transplant were more likely to develop PTDM at 1-year post-transplant. HCV viremia clearance prior to transplant may decrease risk of PTDM in liver transplant recipients. PTDM development is an additional factor to consider when deciding whether to treat patients for HCV viremia prior to transplant.

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