Complications associated with hyperglycemia in liver transplant patients

Abstract

Background: Hyperglycemia is a frequent phenomenon in hospitalized patients that is associated with negative outcomes. It is common in liver transplant patients as a result of stress and is related to immunosuppressant drugs. Although studies are few, a history of diabetes and the presentation of hyperglycemia during liver transplantation have been associated with a higher risk for rejection. Aims: To analyze whether hyperglycemia during the first 48 hours after liver transplantation was associated with a higher risk for infection, rejection, or longer hospital stay. Methods: A retrospective cohort study was conducted on patients above the age of 15 years that received a liver transplant. Hyperglycemia was defined as a value above 140 mg/dl and it was measured in three different manners (as an isolated value, as a mean value, and as a weighted value over time). The relation of hyperglycemia to a risk for acute rejection, infection, or longer hospital stay was evaluated. Results: Some form of hyperglycemia was present in 94% of the patients during the first 48 posttransplantation hours, regardless of its definition. There was no increased risk for rejection (OR: 1.49; 95% CI: 0.55-4.05), infection (OR: 0.62; 95% CI: 0.16-2.25), or longer hospital stay between the patients that presented with hyperglycemia and those that did not.

Outcomes in patients with diabetes 10 years after liver transplantation

“…Hyperglycemia increases the production of cytokines, such as tumor necrosis factor‐α, interleukin (IL)‐1, IL‐6, and IL‐12, adhesion molecules, and dendritic cells, as well as increasing the expression of Class I and II major histocompatibility complex molecules, which may increase the immune response against the graft . Moreover, hyperglycemia increases ischemic damage and the inflammatory reaction associated with reperfusion, apparently mediated by exaggerated leukocyte adhesion to the endothelium …”

Perioperative intensive glycemic control for liver transplant recipients to prevent surgical site infection: A systematic review and meta‐analysis

“…This hypoinsulinemia, combined with insulin resistance and excessive catabolism due to the action of counter‐regulatory hormones, commonly leads to hyperglycemia. Surgical stress is further exacerbated in transplant patients due to massive red blood cells transfusion, the use of vasopressors and other immunosuppressant drugs 16,17 . Therefore, insulin suppression and hyperglycemia are more common and more severe among this group of patients.…”

“…Surgical stress is further exacerbated in transplant patients due to massive red blood cells transfusion, the use of vasopressors and other immunosuppressant drugs. 16,17 Therefore, insulin suppression and hyperglycemia are more common and more severe among this group of patients.…”