New-Onset Diabetes Mellitus and the Analysis of Dipeptidyl-Peptidase-4 After Liver Transplantation G. Gámán*, E. Sárváry, F. Gelley, A. Doros, D. Görög, I. Fehérvári, L. Kóbori, L. Wágner, and B. Nemes Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary ABSTRACT Background. New-onset diabetes mellitus after transplantation (NODAT) is a common complication after orthotopic liver transplantation (OLT). The diabetogenic effect of hepatitis C virus (HCV) infection is well known. The aim of this study was to analyze the glucose homeostasis before and after OLT. The oral glucose tolerance test (OGTT) was carried out, and dipeptidyl-peptidase-4 (DPP-4) activity was measured. Methods. The study period was from 2012 to 2014. We enrolled 49 non-diabetic patients from the waiting list (group A) and 21 patients after OLT (group B). Seven patients were monitored continuously both before and after OLT. According to our preoperative OGTT results, 13 patients in group A had newly diagnosed diabetes mellitus (group A/DM) and 11 had impaired glucose tolerance (group A/IGT). In 25 cases, normal glucose tolerance was diagnosed (group A/NGT). The calculated homeostasis model assessment insulin resistance (HOMA2-IR) values were both in group A/DM and-IGT higher compared with group A/NGT (2.42  0.81 vs 2  0.98 vs 1.28  0.67; P ¼ .001). In the case of HCV infection (n ¼ 14; 29%) DM and IGT were more frequent. Results. Six patients in group B had NODAT. In 9 cases, IGT and in 6 cases NGT was detected. In the case of HCV infection (n ¼ 9; 43%), DPP-4 levels were higher compared with that in patients with all other indications for OLT (15.5  5.2 vs 8.7  3.5; P ¼ .008). We evaluated the same individuals before and after OLT (n ¼ 7), and a decrease in b-cell function was noted. Conclusions. Preoperative OGTT is an important and easy investigation to rule out glucose imbalance before OLT. The HOMA2 calculation can also be useful both in pre- operative and postoperative risk assessment. In our results, DPP-4 activity is not specific for the type of glucose homeostasis imbalance, but, in HCV infection, it is higher. DPP-4 inhibitors can be effective in the therapy of NODAT, especially in HCV-infected patients. N EW-ONSET diabetes mellitus after transplantation (NODAT) is a common complication after orthotopic liver transplantation (OLT) [1,2]. In a former retrospective study, its prevalence was 20%; in the Hungarian liver transplantation program [3], this is similar compared with other centers [4]. Hepatitis C virus (HCV) infection is the leading indication for OLT [5]. The diabetonic effect of HCV is well known. NODAT can be characterized through insulin resistance and insulin hyposecretion [6]. Recent data demonstrate that impaired insulin secretion rather than impaired insulin sensitivity might be the principal patho- physiological defect in NODAT after kidney transplantation [7]. NODAT increases the morbidity and mortality rates after OLT [8]. Several risk factors [9] are known, for example, the diabetogenic effect of HCV, elder age, high body mass index, and positive family history. Furthermore, the preoperative non-recognized blood sugar imbalance, male donor sex, human leukocyte antigen missmatch, or high blood sugar levels before surgery can also raise the risk of NODAT. The effects of calcineurin inhibitors and *Address correspondence to György Gámán, MD, Department of Transplantation and Surgery, Semmelweis University, Baross u. 23-25, H-1082 Budapest, Hungary. E-mail: gyorgy.gaman@ gmail.com ª 2014 by Elsevier Inc. All rights reserved. 360 Park Avenue South, New York, NY 10010-1710 0041-1345/14/$esee front matter http://dx.doi.org/10.1016/j.transproceed.2014.05.062 Transplantation Proceedings, 46, 2177e2180 (2014) 2177