Triacylglycerol‐Based Insulin Resistance Indices and Post‐Transplantation Diabetes Mellitus After Liver Transplantation

BACKGROUND: Post-transplant diabetes mellitus (PTDM) is a common complication following liver transplant (LT) and is associated with adverse outcomes. The triacylglycerol-glucose product (TyG) and the triacylglycerol-to-high-density lipoprotein (HDL) cholesterol ratio (TAG/HDL-c) are indices that can serve as triacylglycerol-based proxies for insulin resistance. Their relation to PTDM in liver-transplant recipients (LTRs) is unclear. METHODS: TyG and TAG/HDL-c (nuclear magnetic resonance spectroscopy) were compared between LTRs without diabetes at baseline and participants without diabetes from the community-dwelling PREVEND cohort. Among LTRs, associations with incident PTDM were determined using Cox regression analysis and logistic regression analysis with adjustment for relevant variables. RESULTS: TyG was higher in 246 LTRs without diabetes (mean age 52.6 years; 53.7% male) compared to 4533 PREVEND participants without diabetes (mean 53.1 years; 48.9% male (p < 0.001), and confirmed using propensity score matching (p < 0.001). Over a median follow-up of 7.1 (IQR 6.2-7.8) years, 31 LTRs developed PTDM (12.6% cumulative incidence). A higher baseline TyG index was associated with an increased risk of PTDM (HR per 1-SD increase: 1.67, 95% CI 1.28-2.30; highest vs. lowest tertile HR: 1.77, 95% CI 1.14-2.64). The TAG/HDL-c ratio followed the same trend (HR per 1-SD increase: 1.56, 95% CI 1.14-2.15; highest vs. lowest tertile: HR 3.80, 95% CI 1.73-10.0). Findings remained in adjusted analyses and were directionally similar in logistic regression models. CONCLUSIONS: In LTRs, both the TyG index and the TAG/HDL-c ratio are associated with PTDM. These indices could serve as a basis for post-transplant risk stratification in diabetes development.