The impact of preexisting and post-transplant diabetes mellitus on outcomes following liver transplantation

Background: Diabetes mellitus (DM) is said to adversely affect transplant outcomes. The aim of this study was to investigate the impact of pre-existing and post-transplant DM on liver transplant (LT) recipients.Method: A single centre retrospective analysis of prospectively collected data of LT recipients (1990–2015) was undertaken.Results: Of the 2,209 patients, 13% (n=298) had Pre-DM, 16% (n=362) developed PTDM, 5% (n=118) developed transient hyperglycemia (t-HG) post-LT, and 65% (n=1,431) never developed DM (no DM). Baseline clinical characteristics of patients with PTDM was similar to that of patients with pre-DM. Incidence of PTDM peaked during first-year (87%) and plateaued thereafter. On multivariate analysis (Bonferroni-corrected), non-alcoholic fatty liver disease and the use of Tacrolimus and Sirolimus use were independently associated with PTDM development. Both Pre-DM and PTDM patients had satisfactory and comparable glycaemic control throughout the follow-up period. Those who developed t-HG seems to have a unique characteristic compared to others. Overall, 9%, 5%, and 8% developed end-stage renal disease (ESRD), major cardiovascular event (mCVE), and de novo cancer, respectively. Both Pre-DM and PTDM did not adversely affect patient survival, re-LT, or de novo cancer. The risks of ESRD and mCVE were significantly higher in patients with Pre-DM followed by PTDM and no DM.Conclusions: In this largest non-registry study, patients with pre-DM and PTDM share similar baseline clinical characteristics. Pre-DM increases the risk of ESRD and mCVE; however, patient survival was comparable to those with PTDM and without diabetes. Understanding the impact of PTDM would need prolonged follow-up

Long-term outcomes of liver transplant recipients followed up in non-transplant centres: care closer to home

Introduction: Increasing rates of liver transplantation and improved outcomes have led to greater numbers of transplant recipients followed up in non-transplant centres. Our aim was to document long-term clinical outcomes of liver transplant recipients managed in this ‘hub and spoke’ healthcare model.Methods: A retrospective analysis of all adult patients who underwent liver transplantation between 1987 and 2016, with post-transplant follow-up in two non-transplant centres in the UK (Nottingham) and Canada (Ottawa) was performed.Results: The 1-, 5-, 10- and 20-year patient survival rates were 98%, 95%, 87% and 62%, and 100%, 96%, 88% and 62% in the Nottingham and Ottawa groups, respectively (p=0.87). There were no significant differences between the two centres in 1-, 5-, 10- and 20-year cumulative incidence of death-censored graft-survival (p=0.10), end-stage renal disease (p=0.29) or de novo cancer (p=0.22). Nottingham had a lower incidence of major cardiovascular events (p=0.008).Conclusion: Adopting a new model of healthcare provides a means of delivering post-transplant patient care close to home, without compromising patient survival and long-term clinical outcomes

Magnetic Susceptibility and Radiological Hazardous Nature of the River Sediments - Spectroscopical Approach

Magnetic susceptibility, radioactivity and mineralogical characterization are performed on 40 sediment samples collected from the Ponnaiyar river, Tamilnadu, to establish a possible link between the enhanced concentration of anthropogenic magnetic particles, radionuclides and minerals. Higher magnetic susceptibility values (> 150 × $10^{-8} m^3$/kg) are observed in last 100 km of the river. However, some elevated values are also observed in first 100 km. Frequency dependence of magnetic susceptibility is calculated to understand the magnetic grain variations which are presented and discussed. The average activity concentration of radionuclides ($\text{}^{238}U,$ $\text{}^{232}Th$ and $\text{}^{40}K$) falls within the typical world and Indian average values although some extreme values are determined. To assess the radiological hazard of river sediments, radiological hazard indices such as absorbed dose rate, annual effective dose equivalent, radium equivalent, hazard indices ($H_{ex}$, $H_{in}$, Iγ, I and excess lifetime cancer risk) are calculated which shows below the internationally recommended values. The relative distribution of major minerals is determined by calculating extinction coefficient. Correlation analysis is carried out between the parameters obtained from radioactivity analysis and other analyses to know the existing relations. Obtained correlations are discussed and suggest that the natural radioactivity level and magnetic susceptibility of the present sediments is mainly controlled by clay content

Magnetic Susceptibility and Radiological Hazardous Nature of the River Sediments - Spectroscopical Approach

Magnetic susceptibility, radioactivity and mineralogical characterization are performed on 40 sediment samples collected from the Ponnaiyar river, Tamilnadu, to establish a possible link between the enhanced concentration of anthropogenic magnetic particles, radionuclides and minerals. Higher magnetic susceptibility values (> 150 × $10^{-8} m^3$/kg) are observed in last 100 km of the river. However, some elevated values are also observed in first 100 km. Frequency dependence of magnetic susceptibility is calculated to understand the magnetic grain variations which are presented and discussed. The average activity concentration of radionuclides ($\text{}^{238}U,$ $\text{}^{232}Th$ and $\text{}^{40}K$) falls within the typical world and Indian average values although some extreme values are determined. To assess the radiological hazard of river sediments, radiological hazard indices such as absorbed dose rate, annual effective dose equivalent, radium equivalent, hazard indices ($H_{ex}$, $H_{in}$, Iγ, I and excess lifetime cancer risk) are calculated which shows below the internationally recommended values. The relative distribution of major minerals is determined by calculating extinction coefficient. Correlation analysis is carried out between the parameters obtained from radioactivity analysis and other analyses to know the existing relations. Obtained correlations are discussed and suggest that the natural radioactivity level and magnetic susceptibility of the present sediments is mainly controlled by clay content