A1C and diabetes control before liver transplant list

[Ginabeez]

I work for a family practice physician. He asked me to find out something. Not sure where to go to find the answer he seeks. What must an A1C be in order for a patient to be considered for a transplant list. We have a patient that was on a transplant list but has been removed. He stated that it was due to his Diabetes being uncontrolled. He is a new patient for us. We have sent for his records. The doctor gave me the assignment to find the answser. I think he was seeing what a good detective I am. I have been searching the internet but haven't found the answer. Does anyone have any idea or can you point me in the right direction to find the answer!!

[Ginabeez]

I did talk to the his GI doctor's office on Thursday. They had instructed him that his A1C needed to be under 8.0 for him to be reconsidered. We ran his A1C and it was 6.6 which was down from the 8.20 in Jan. The GI and the other specialistare  planning on reevaluating him. We started him on Insulin. I understand he has NASH.  We will see what they say with their preliminary blood work. Thanks Gina

[mikesimon]

I am reluctant to say this but alcohol/substance abuse is an exclusionary factor. Since you don't have much experience with this patient have you considered that something else might be at play here? What is his HbA1c, by the way? Mike

[mikesimon]

I haven't heard of DM preventing anyone from being listed for transplant. A person on dialysis can't be listed listed but I haven't known of HbA1c excluding anyone. I did find this article which doesn't answer your question but addresses the issue.

www3.interscience.wiley.com/cgi-bin/abstract/106597450/ABSTRACT?CRETRY=1&SRETRY=0

The influence of preexisting diabetes mellitus (DM) on outcome after orthotopic liver transplantation (OLT) has not been well defined. The objective of our study was to compare the morbidity and mortality after OLT in 57 patients with preexisting DM (3 type I, 54 type II) with 114 age-, sex-, and race-matched patients without DM (case controls). The demographics were similar in both groups. Pretransplantation serum creatinine was significantly higher in the diabetic group compared with case controls. The incidence of the following complications was significantly higher in the diabetic group after OLT: cardiovascular (61.4% vs. 21.9%, P < .001), major (54.4% vs. 29.8%, P = .002) and minor infections (29.8% vs. 7.9%, P < .0001), renal (59.7% vs. 20.2%, P < .001), ophthalmologic (10.5% vs. 0.9%, P = .01), respiratory (24.6% vs. 7.0%, P = .001), neurologic (31.6% vs. 7.0%, P < .001), hematologic (19.3% vss 2.6%, P = .001), musculoskeletal (24.6% vs. 5.3%, P = .001), and malignancy (22.8% vs. 10.5%, P = .03). The duration of hospital stay, cost of hospitalization, retransplantation, and overall graft survival were similar. Acute rejection was seen in 50.9% of diabetics compared with 25.4% in controls (P = .0009). One-year (87% vs. 77%) and 2-year (81.6% vs. 70.1%) patient survival was similar, but 5-year survival was lower in the DM group (34.4% vs. 67.7%, P = .002). In conclusion, preexisting diabetes is associated with a significant post-OLT morbidity and mortality, and our observations suggest that patients with DM warrant more rigorous pre- and post-OLT evaluation.