# Assessment of hepatic fibrosis with non-invasive indices in subjects with diabetes before and after liver transplantation

## TL;DR

This study finds that diabetes persistence after liver transplantation is linked to higher liver fibrosis risk in transplanted livers.

## Contribution

The study is the first to assess the impact of post-transplant diabetes on fibrosis in transplanted livers using non-invasive indices.

## Key findings

- Pre-transplant diabetic subjects had significantly higher FIB-4 and APRI scores compared to non-diabetic subjects.
- Two years post-transplant, diabetic subjects still showed significantly higher fibrosis indices compared to non-diabetic subjects.
- Persistence of diabetes after transplantation is a risk factor for fibrosis development in the new liver.

## Abstract

One of the most common complications of cirrhosis is diabetes, which prevalence is strictly related to severity of hepatopathy. Actually, there are no data on the persistence of post-transplant glucose abnormalities and on a potential impact of diabetes on development of fibrosis in the transplanted liver. To this aim, we evaluated liver fibrosis in cirrhotic subjects before and after being transplanted.

The study included 111 individuals who had liver transplantation. The assessment was performed before and two years after surgery to investigate a potential impact of the persistence of diabetes on developing de novo fibrosis in the transplanted liver. The degree of fibrosis was assessed using the Fibrosis Index Based on 4 Factors (FIB-4) and the Aspartate to Platelet Ratio Index (APRI).

At pre-transplant evaluation, 63 out of 111 (56.8%) subjects were diabetic. Diabetic subjects had higher FIB-4 (Geometric mean, 95% confidence interval: 9.74, 8.32-11.41 vs 5.93, 4.71-7.46, P<0.001) and APRI (2.04, 1.69-2.47 vs 1.18, 0.90-1.55, P<0.001) compared to non-diabetic subjects. Two years after transplantation, 39 out of 111 (35.1%) subjects remained with diabetes and continued to show significantly higher FIB-4 (3.14, 2.57-3.82 vs 1.87, 1.55-2.27, P<0.001) and APRI (0.52, 0.39-0.69 vs 0.26, 0.21-0.32, P<0.001) compared to subjects without diabetes.

Thus, persistence of diabetes after surgery is a possible risk factor for an evolution to fibrosis in the transplanted liver, potentially leading to worsened long-term outcomes in this population.