Influence of Immunosuppression and Effect of Hepatitis C Virus on New Onset of Diabetes Mellitus in Liver Transplant Recipients

Sánchez-Pérez, Belinda; Narváez, José Manuel Aranda; Santoyo-Santoyo, Julio; Fernández-Aguilar, José Luis; Muñóz, Miguel Ángel Suárez; González-Sánchez, Antonio Jesús; Daga, J.A. Pérez; Plaza, César Pablo Ramírez; Campos, Joaquín; Mazure, Carolina Jiménez; Ortiz, Ruth

doi:10.1016/j.transproceed.2008.08.116

Cited by 18 publications

(12 citation statements)

References 6 publications

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“…Further support for HCV as a risk factor for PTDM comes from small studies suggesting that treatment to clear HCV before kidney transplant may reduce the risk of PTDM after transplant (125,126). In liver and kidney transplant recipients, the risk of PTDM is even higher in those who have HCV and are treated with tacrolimus-based immunosuppression, compared to either risk factor alone (40,127,128).…”

Section: Potential Role Of "Stress" Inflammation and Infectionmentioning

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: Potential Role Of "Stress" Inflammation and Infectionmentioning

confidence: 99%

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

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

239

203

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“…The association between immunosuppression with tacrolimus, HCV and post-transplant diabetes or impaired fasting glucose has been reported [91] . The choice of immunosuppressive treatment might be decided on the basis of the patient's pretransplantation status.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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“…We have shown that the pretransplant and 1‐year post‐transplant prevalence of diabetes is higher in patients with CHC than in other causes of liver disease independent of antirejection steroid dose (22), a finding that has since been reaffirmed (55–58). Diabetics who undergo liver transplantation have a higher rate of liver‐related (e.g.…”

Section: Consequences Of Metabolic Disturbances In Chronic Hepatitis Cmentioning

confidence: 87%