HCV Causes Insulin Resistance Post Transplant

[Rainbow]

Liver Transpl. 2008 Feb;14(2):193-201.

Prospective study of liver transplant recipients with HCV infection: evidence for a causal relationship between HCV and insulin resistance.

Delgado-Borrego A, Liu YS, Jordan SH, Agrawal S, Zhang H, Christofi M, Casson D, Cosimi AB, Chung RT.
Gastrointestinal Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.

An association between hepatitis C virus (HCV) infection and insulin resistance (IR) has been recently reported. However, causality has not been established. The cross-sectional nature of most reported studies and varying degrees of fibrosis have limited definitive conclusions about the independent role of HCV in development of IR. We sought to evaluate whether HCV induces IR by prospectively analyzing a cohort of adult liver transplant (LT) recipients. A total of 34 adults (14 HCV(+) and 20 HCV(-)) who underwent consecutive LT were followed during the first year posttransplantation. IR was estimated using the homeostasis model assessment (HOMA). Univariate and multivariate repeated measures analyses and Cox regression models were used. There were no significant differences between the groups with respect to age, body mass index (BMI), family history of diabetes, alcohol consumption, or laboratory indices. The cohort had no or minimal fibrosis. There was lower prednisone use in the HCV(+) group, and no difference in the use of tacrolimus between the two groups was found. IR was 77% higher in HCV(+) subjects during the first year post-LT when controlling for BMI (P = 0.035). Subjects with high HCV ribonucleic acid (RNA) levels reached high HOMA-IR significantly earlier than those with lower HCV RNA (P = 0.03). Following the first month post-LT, HCV(+) subjects were 4 times more likely to become diabetic than HCV(-) controls (P < 0.01). In conclusion, there is significantly higher IR in the HCV(+) group during the first year post-LT. This cannot be explained by differences in BMI, medications used, alcohol consumption, or degree of fibrosis. Higher HCV RNA levels were associated with earlier elevations in HOMA-IR. Collectively, these results provide strong evidence that HCV induces the development of Insulin Resistance.

http://www.ncbi.nlm.nih.gov/pubmed/18236394?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
 

[robin]

Probably has something to do with the liver storing glycogen and the hep continually annoys the liver. I was lucky...had to cover my blood sugar only a few months after transplant and never really had a big problem. Managed to keep my sugar below 204 (my highest recorded) and since going off Prograf to Gengraf...have absolutely not problems. Thanks for this article. I know I had read that a relatively high percentage of transplant patients end up insulin dependent so I've been careful to NOT fall in that category. Keep your spirits high...robin

[Rainbow]

You're right.  It's the large amount of sugar disgorged from the liver that causes the insulin resistance....and sometimes need for injected insulin.   

[19Dragon52]

{{{Rainbow}}}

I wanted to Thank You for posting this info.  It helps us to know & understand our Liver Transplant Community here on the board...Robin, Hank and those that are on Transplant Lists or are soon to be headed that way.  It helps so much to have an incling on how to be supportive to those that have to go beyond the Standard TX.

Thanks Again.....