A Randomized Controlled Trial to Evaluate the Effect of Glycemic Control on Renal Transplantation Outcomes

Hermayer, Kathie L.; Egidi, Maria Francesca; Finch, Nancy J.; Baliga, Prabhakar K.; Lin, Angello; Kettinger, Lindsey; Biggins, Shari; Carter, Rickey E.

doi:10.1210/jc.2012-1979

Cited by 46 publications

(28 citation statements)

References 28 publications

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“…Specific glycemic targets have not been established for patients in the immediate post-transplant setting. However, data from a study in kidney transplant recipients suggest that tight glycemic control (blood glucose goal, 70 -110 mg/dL) is associated with increased hypoglycemia and may increase the risk for future rejection episodes compared to standard blood glucose control (blood glucose goal, 70 -180 mg/dL) (166). Thus, for transplant recipients, it seems reasonable to follow current general practice guidelines for inpatient blood glucose goals (intensive care unit blood glucose goal, 140 -180 mg/dL; non-intensive care unit premeal blood glucose goal, Ͻ140 mg/dL; random blood glucose goal, Ͻ180 mg/ dL) (167).…”

Section: A Treatment Of the Hospitalized Patientmentioning

confidence: 99%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

239

203

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and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. PTDM has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. An international consensus panel recommended a consistent set of guidelines in 2003 based on American Diabetes Association glucose criteria but did not exclude the immediate post-transplant hospitalization when many patients receive large doses of corticosteroids. Greater glucose monitoring during all hospitalizations has revealed significant glucose intolerance in the majority of recipients immediately after transplant. As a result, the international consensus panel reviewed its earlier guidelines and recommended delaying screening and diagnosis of PTDM until the recipient is on stable doses of immunosuppression after discharge from initial transplant hospitalization. The group cautioned that whereas hemoglobin A1C has been adopted as a diagnostic criterion by many, it is not reliable as the sole diabetes screening method during the first year after transplant. Risk factors for PTDM include many of the immunosuppressant medications themselves as well as those for type 2 diabetes. The provider managing diabetes and associated dyslipidemia and hypertension after transplant must be careful of the greater risk for drug-drug interactions and infections with immunosuppressant medications. Treatment goals and therapies must consider the greater risk for fluctuating and reduced kidney function, which can cause hypoglycemia. Research is actively focused on strategies to prevent PTDM, but until strategies are found, it is imperative that immunosuppression regimens are chosen based on their evidence to prolong graft survival, not to avoid PTDM. (Endocrine Reviews 37: 37-61, 2016)

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Section: A Treatment Of the Hospitalized Patientmentioning

confidence: 99%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

239

203

View full text Add to dashboard Cite

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“…However, to date, no studies suggest a benefit of perioperative glycemic control beyond that recommended for all hospitalized patients on mortality after kidney transplant [60•].…”

Section: Long-term Consequences Of Perioperative Glucose Controlmentioning

confidence: 99%

“…The one randomized control study of kidney transplant recipients designed to assess the impact of tighter control during the immediate hospitalization (70–110 vs <180 mg/dL) did not improve any outcome, and the intensive group experienced not only more hypoglycemia but also more rejection episodes, although the latter was not statistically significant [60•]. While it might be tempting to assume that tighter control would improve outcomes after heart transplant, in particular, there are no published studies.…”

Section: Glucose Goals and General Approachmentioning

confidence: 99%

Management of the Hospitalized Transplant Patient

et al. 2015

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Significant hyperglycemia is commonly observed immediately after solid organ and bone marrow transplant as well as with subsequent hospitalizations. Surgery and procedures are well known to cause pain and stress leading to secretion of cytokines and other hormones known to aggravate insulin action. Immunosuppression required for transplant and preexisting risk are also major factors. Glucose control improves outcomes for all hospitalized patients, including transplant patients, but is often more challenging to achieve because of frequent and sometimes unpredictable changes in immunosuppression doses, renal function, and nutrition. As a result, risk of hypoglycemia can be greater in this patient group when trying to achieve glucose control goals for hospitalized patients. Key to successful management of hyperglycemia is regular communication between the members of the care team as well as anticipating and rapidly implementing a new treatment paradigm in response to changes in immunosuppression, nutrition, renal function, or evidence of changing insulin resistance.

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“…Specifically, appropriate glycaemic targets during the transplant admission are not clear. During the transplant admission, there is evidence of harm from both hypoglycaemia [4] and hyperglycaemia [5]; how these relationships are modified by pretransplant diabetes status is not clear. Understanding any impact of glycaemia on outcomes may provide support to determine appropriate glucose targets.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Different Glycaemic States on Renal Transplant Outcomes

Sheu

Depczynski

O’Sullivan

et al. 2016

Journal of Diabetes Research

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Background. Optimal glycaemic targets following transplantation are unknown. Understanding the impact of DM and posttransplant diabetes mellitus (PTDM) may improve patient and graft survival in transplant recipients. Aim. To determine the perioperative and one-year outcomes after renal transplantation and whether these outcomes are affected by preexisting DM, PTDM, or glycaemia during transplant admission. Method. Adult recipients of renal transplants from a single centre over 5.5 years were retrospectively reviewed. Measured outcomes during transplant admission included glycaemia and complications (infective complications, acute rejection, and return to dialysis) and, at 12 months, glycaemic control and complications (cardiovascular complication, graft failure). Results. Of 148 patients analysed, 29 (19.6%) had DM and 27 (18.2%) developed PTDM. Following transplantation, glucose levels were higher in patients with DM and PTDM. DM patients had a longer hospital stay, had more infections, and were more likely return to dialysis. PTDM patients had increased rates of acute rejection and return to dialysis. At 1 year after transplant, there were more cardiovascular complications in DM patients compared to those without DM. Conclusions. Compared to patients without DM, patients with DM or PTDM are more likely to suffer from complications perioperatively and at 12 months. Perioperative glycaemia is associated with graft function and may be a modifiable risk.

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A Randomized Controlled Trial to Evaluate the Effect of Glycemic Control on Renal Transplantation Outcomes

Abstract: The primary outcome measure of DGF was not statistically different for the two treatment groups. Regarding longer-term rejection and graft survival, the intensively treated participants were at higher risk for a rejection episode.

Cited by 46 publications

References 28 publications

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Management of the Hospitalized Transplant Patient

The Effect of Different Glycaemic States on Renal Transplant Outcomes

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