*Purpose: Transient hyperglycemia after liver transplant (LT) is common due to the use of high-dose steroids at the time of transplant, but some patients may progress to true diabetes mellitus (DM). New-onset DM after transplantation (NODAT) is associated with an increased risk for cardiovascular disease, chronic kidney disease, and rejection. Differentiation between transient hyperglycemia and NODAT is important as patients with transient hyperglycemia may not need long term antidiabetic therapy. Extended use of antidiabetic therapy in transient hyperglycemia increases the risk for adverse effects such as hypoglycemia. The purpose of this study is to assess insulin prescribing practices after LT and categorize the duration of insulin use in patients with no prior history of DM.

*Methods: This study was a single-center, retrospective cohort analysis of liver transplant recipients between July 1, 2018 to June 1, 2019 at our institution. The primary outcome was proportion of patients without prior history of DM discharged on insulin who were requiring insulin at 3 months from discharge after transplant. Key secondary outcomes included proportion of patients required insulin at 12 months from discharge and incidence of biopsy proven acute rejection at 12 months.

*Results: A total of 47 patients were included in the preliminary analysis. Approximately 9% of patients were on an antidiabetic medication prior to LT. At discharge, 12 patients without history of DM were prescribed insulin after transplant. Of these patients, 33% required insulin at the 3 month follow-up. Twelve months after discharge three patients (25%) remained on insulin. Follow-up data was unavailable for six patients in the overall population at both time points. Three patients who were not prescribed insulin at discharge required insulin after LT, one at month 3 and two at month 12. No patients were discharged on oral antidiabetic medications. Biopsy proven acute rejection occurred in three patients within the 12 months after discharge from LT.

*Conclusions: The preliminary results of this study suggest that the majority of patients with no prior history of DM do not require long term insulin therapy after LT. Many of the patients who received a prescription for insulin at discharge did not require insulin during the first year post-transplant. Use of oral antidiabetic medications in this population was low, but it is possible that some patients could have achieved sufficient blood glucose control with oral medications alone.

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