Background: Hepatitis C (HCV) is the leading indication for liver transplant in the US. HCV recurrence after transplant is universal and metabolic abnormalities are common in patients with HCV infection. This can contribute to fibrosis progression and a decline in graft and patient survival rates. The impact of glycemic control on the rate of graft loss and patient death has not been well studied.

Methods: This was a retrospective longitudinal cohort study of all liver recipients transplanted for HCV at our institution between Jan 2000 and June 2011. Patients were excluded if they were <18 years old. Patients were compared for baseline characteristics and outcomes based on graft loss and death. Glycemic control was defined as mean HgbA1C <7% or mean serum glucose <150 mg/dL, blood pressure control was defined as average BP <130/80, and lipid control was defined as an average LDL <100 mg/dL.

Results: 239 liver transplants for HCV were performed over this time period. Baseline characteristics and clinical outcomes are displayed in Table 1 and 2. Baseline characteristics were similar between those that had graft loss to those that did not, although recipient and donor age were higher in those that had graft loss. No differences in graft loss or death were seen when comparing glycemic control after the first year post-transplant, hypertension control, and lipid control. However, patients who had glycemic control in the first year after transplant had improved patient and graft survival (p<0.03). The Kaplan-Meier Survival Analyses demonstrated patient (Figure 1) and graft survival (Figure 2) were significantly improved in patients with early glycemic control after transplant.

Conclusion: Of the three metabolic abnormalities compared (hypertension, dyslipidemia, and hyperglycemia), only early glycemic control following transplant significantly improved patient and graft survival. Future efforts and studies should be focused on reducing the impact of this important modifiable risk factor.

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