Assessment of Insulin Resistance in Egyptian HCV End-stage Cirrhotic Patients Before and After Living Donor Liver Transplantation (LDLT)

Abstract

SUMMARY H CV virus has been shown to induce insulin resistance (IR) itself and thereby to promote hepatic inflammation and fibrosis. The aim of this work was to evaluate HCV-induced IR in Egyptian HCV cirrhotic patients after LDLT and to correlate the occurrence of IR with the level of HCV-RNA viremia and the status of HCV disease recurrence post LDLT. To fulfill our aim, 67 patients had received LDLT at Ain Shams center for Organ Transplantation (ASCOT) from November 2010 to November 2012. 17 of them were included in this prospective research by the following criteria: 1) Egyptian patients aged from 18-60 years who were accepting participation in the study and signing a written consent form. 2) Patients with HCV related End Stage Liver Disease, who were eligible for liver transplantation. 3) Patients with an estimate of IR using HOMA-IR level≥ 2 ± (impaired fasting plasma glucose (FPG) and/or impaired oral glucose tolerance test (OGTT). Patients were followed up with the following schedule: During the 1st month FPG was assessed weekly then, FPG, OGTT and HOMA were routinely done 3, 6 and 12 months post LDLT. HCV RNA level by PCR was performed 1, 6 and 12 months to follow up the level of viremia post LDLT. Protocol liver biopsies were taken 6 and 12 months post LDLT. Results of our study that, the mean FPG showed statistically significant increase at 3, 6 and 12 months post LDLT with p value <0.05. Although there was a drop in the 2HPG-75g OGTT during the first year post LDLT, this drop was not statistically significant at 3, 6 and 12 months There was no statistically significant change regarding FPG ' percentage during the 1st year following LT. There was statistically significant reduction of impaired glucose tolerance (IGT) patients' percentage during the 1st year post LDLT. This reduction was highly significant (p value=0.021) 6 months and 12 months post LDLT. The incidence of New Onset Diabetes Mellitus (NODM) at 6 months was 5.8% (1 patient) and 11.7 % (2 patients) at 1 year post LDLT, these results were statistically insignificant. The median FSI shows statistically significant reduction after LDLT to reach the lowest value at 6 months (highly significant reduction, p value<0.01) with a modest increase at 12 months (however, the reduction is still significant, p value<0.01) post LDLT, indicating an improvement of fasting hyperinslinemia during the 1st year post LDLT. Improvement of the median HOMA value during the 1st year post LDLT, which was not significant at 3 months post LDLT (p value=0.055), was highly significant at 6 months post LDLT (p value=0.002) and was again significant at 12 months post LDLT (p value=0.028). Recurrence of HCV-disease was documented histologically in 8 patients (47%) at 6 months and 1year post LDLT. There was no statistically significant relation between median HOMA values and either level of HCV-RNA viremia or histological recurrence of HCV 6 and 12 months post LDLT. To our knowledge, this is the first study of HCV-induced IR that was conducted on LDLT recipients. HCV-induced insulin resistance is improved 1 year after LDLT.