Glycemic Control and Organ Transplantation

Abstract

A discussion of hyperglycemia during organ transplantation is a broad topic that includes patients with a known history of diabetes pretransplant, those at risk for post-transplant diabetes, those with stress-induced hyperglycemia, those with hyperglycemia related to immunosuppressive therapy, and hyperglycemia in the deceased organ donor. In contrast to the plethora of articles and studies describing perioperative and critical care management of hyperglycemia in cardiac, trauma, and medical/surgical intensive care unit patients, relatively few published articles in the field of organ transplantation can be found. This article consists of a review of available literature in the form of publications and abstracts, and a preliminary report of the authors' work with liver transplantation and deceased organ donors.

Erythropoietin protects myocardium against ischemia–reperfusion injury under moderate hyperglycemia

“…Bars with different superscript letters are significantly differentiation from each other (*Po 0.05). aggravating inflammatory response and ischemic organ damage (Hekmat and Eshraghi, 2010;Marvin and Morton, 2009). Acute and chronic HG were reported to be associated with increased apoptosis, mitigated activities targeted to organ protective pathways, impaired nitric oxide (NO) availability (Giugliano et al, 1997), and excessive reactive oxygen species production during I/R (Capes et al, 2000).…”

Blood Glucose Regulation During Living-Donor Liver Transplant Surgery

“…Additional investigations of hyperglycemia prevention and management are needed. 10 We hope that our study will provide some knowledge in this area.…”

“…The vast majority of studies are abstracts of congress and retrospective studies performed in large centers. 9,10 The management of hyperglycemia during the perioperative period is always a challenge to anesthesiologists, surgeons, and intensivists. Over the years and throughout the literature, controversy has surrounded the blood glucose target levels and methods for controlling it.…”

Perioperative Care of the Liver Transplant Patient

“…[104][105][106][107] There are insufficient data regarding peritransplant glycemic control, although it has been suggested that graft function may be affected by plasma glucose levels. [108][109][110][111][112][113] Perioperative hypoglycemia is of great concern because of the predisposition to its development in patients with liver dysfunction and altered glycogen stores, and especially those with ALF. Continuous infusion is typically initiated in the OR to maintain glycemic control and continued postoperatively.…”