Morbidity in patients with posttransplant diabetes mellitus following orthotopic liver transplantation

Abstract

It is not well understood whether posttransplant diabetes mellitus (PTDM) following orthotopic liver transplantation (OLTx) alters postoperative morbidity. This study was designed to evaluate this question. All adult patients who received an OLTx between July 1985 and March 1993 (n = 497) were evaluated by retrospective chart review for evidence of PTDM after OLTx. The patients identified with PTDM (n = 26) were case matched with nondiabetic OLTx recipients based on primary liver disease diagnosis, age, gender, date of first OLTx, and survival. Liver synthetic function, number and severity of rejection episodes, graft survival, total number of hospital days within the first year post-OLTx, renal function, and number and type of infection episodes were analyzed to assess differences in morbidity between the PTDM and control patients after OLTx. Of the 497 adult patients who underwent OLTx, 26 (5.2%) were identified as having PTDM within 1 month of discharge. Factors which identified individuals at mmunosuppression has allowed solid organ trans-I plantation to succeed but not without morbidity, including insulin-requiring diabetes mellitus (DM) associated with immunosuppression protocols. The development of DM after solid organ transplantation was first described by Starz12 in 1964 in renal transplant recipients. Posttransplantation DM (PTDM) is estimated to occur in 10% to 46% of all ludney3-'j and 9% to 21% of all liver transplant patients7-I2 The pathogenesis of PTDM is believed to be multifactorial. High-dose prednisone increases peripheral tissue higher risk for DM after OLTx included higher pre-OLTx fasting blood glucose (P = .04); lower body mass index after OLTx (P = .02); and cyclosporine rather than OKT3 induction (P = .009).Graft survival, synthetic function, and the total number of rejection episodes during the first year were not different between the two groups. The morbidity variables of total number of days in the hospital during the first 12 months, renal function, and type and number of infections were also similar between the two groups. In summary, 5.2% of adult patients developed DM within 1 month of OLTx. Pre-existing insulin resistance, postoperative stress, and immunosuppression medications all likely contribute to the development of overt hyperglycemia after OLTx. Although PTDM can be a consequence of OLTx, it does not have a significant impact on patient outcome in the first year after OLTx.

Long-term management of the liver transplant patient: Diabetes, hyperlipidemia, and obesity

“…18,19 When de novo posttransplant insulin-dependent diabetes is strictly defined as diabetes presenting beyond the first postoperative month but within 30 days of discharge, the prevalence is 5.2%, but a need for long-term insulin therapy does not necessarily ensue. 20 In fact, when patients who develop de novo posttransplant diabetes are followed for 3 years, the prevalence of insulin use falls progressively from 26% at 1 year, to 9% at 2 years, and to 1% at 3 years. 17 Posttransplant diabetes is more likely in patients with pretransplant diabetes (than in nondiabetics), in those with high pretransplant blood sugar levels, 18,20 and in those who have many episodes of steroid-resistant rejection.…”

“…20 In fact, when patients who develop de novo posttransplant diabetes are followed for 3 years, the prevalence of insulin use falls progressively from 26% at 1 year, to 9% at 2 years, and to 1% at 3 years. 17 Posttransplant diabetes is more likely in patients with pretransplant diabetes (than in nondiabetics), in those with high pretransplant blood sugar levels, 18,20 and in those who have many episodes of steroid-resistant rejection. 20 The results of at least three studies have suggested that diabetes is more likely to occur in patients who receive a liver transplantation for hepatitis C than other diagnoses.…”

“…17 Posttransplant diabetes is more likely in patients with pretransplant diabetes (than in nondiabetics), in those with high pretransplant blood sugar levels, 18,20 and in those who have many episodes of steroid-resistant rejection. 20 The results of at least three studies have suggested that diabetes is more likely to occur in patients who receive a liver transplantation for hepatitis C than other diagnoses. 16,21,22 The validity of this intriguing suggestion is as yet unclear and, in this context, it is still unresolved whether hepatitis C is a risk factor for diabetes in the nontransplant population.…”

Conversion from calcineurin inhibitors to mycophenolate mofetil in liver transplant recipients with diabetes mellitus

“…Despite the lack of universal agreement, some studies have observed worsened short-and mid-term survival among diabetic LT recipients. [1][2][3][4][5][6][7] Furthermore, DM is a wellknown risk factor for cardiovascular disease, which is one of the leading causes of death of LT recipients in the long term. 8 Calcineurin inhibitors (CI) also predispose to DM through islet cell toxicity, diminished insulin synthesis or release, as well as decreased peripheral insulin sensitivity.…”

Postoperative Effects of Intraoperative Hyperglycemia in Liver Transplant Patients

“…High blood glucose levels that may be observed for various reasons during liver transplant may negatively affect postoperative morbidity and mortality. 6 Many treatments such as immunosuppressive drugs used after liver transplant, blood and blood product replacements, mechanical ventilation, invasive procedures for diagnosis and treatment, and catheterizations are risk factors for various infections. 7 In this study, we aimed to determine the effects of intraoperative hyperglycemia on postoperative outcomes in orthotopic liver transplant recipients.…”