Assessment of Hepatic Fibrosis with Noninvasive Parameters in Subjects with Alterations of Glucose Metabolism before and after Liver Transplantation

Hepatogenous diabetes is a known complication of cirrhosis and its prevalence increases with the severity of liver disease. Regarding to the post-transplant period, no data are currently available to correlate the persistence of alterations in glucose metabolism and the possible development of fibrosis in the transplanted organ. For this reason, we estimated the degree of liver fibrosis and its correlation with the presence of hepatogenous diabetes in 87 subjects affected by cirrhosis. The degree of fibrosis was estimated using the Fibrosis-4 Score (FIB-4) and the Aspartate to Platelet Ratio Index (APRI), which, in literature, best correlate with the degree of stiffness found with fibroscan. Among this population, 78 subjects underwent liver transplantation and were reevaluated 2 years later, in order to evaluate the possible influence of the persistence of post-transplant diabetes in developing new fibrosis in the transplanted organ. At pre-transplant evaluation, 39 of the 87 subjects were diabetic. Both FIB-4 and APRI indices were significantly higher in these patients than in nondiabetic patients (respectively: 12.21 ± 8.27 vs. 7.97 ± 6.89, P = 0.01 and 2.92 ± 2.62 vs. 1.75 ± 1.59, P = 0.01).2 years after transplantation, 35 of the 78 subjects were still diabetic and, again, showed a significantly higher FIB-4 if compared to nondiabetic patients (3.22 ± 2.80 vs. 2.13 ± 1.51, P = 0.03). In conclusion, the increased fibrosis indexes found in diabetic subjects with cirrhosis reflect a more advanced stage of liver disease if compared to nondiabetic patients. Moreover, the persistence of diabetes after transplantation exposes subjects to an increased risk of developing fibrosis in the newly transplanted organ, with the possible consequent worsening of the long-term outcomes in this population. Disclosure V. Grancini: None. A. Gaglio: None. V. Resi: None. E. Palmieri: None. E. Orsi: None.