Association of Hyperglycemia on Allograft Function in the Early Period After Renal Transplantation

Ganji, M.R; Charkhchian, Malihe; Hakemi, Monir Sadat; Nederi, G.H.; Solymanian, T.; Saddadi, Fereshteh; Amini, Manouchehr; Najafi, Iraj

doi:10.1016/j.transproceed.2007.03.030

Cited by 25 publications

(11 citation statements)

References 8 publications

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“…Rejection rates were significantly higher in those with an average glucose level > 200 even following adjustment for confounding variables. This association has been demonstrated after kidney transplantation, but, to our knowledge, has not been shown after liver or other solid organ transplantation (7,8, 11,12). While graft survival was not different between those with and without rejection, patients that developed rejection had more related morbidity, i.e.…”

Section: Discussionmentioning

confidence: 56%

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Posttransplant Hyperglycemia is Associated With Increased Risk of Liver Allograft Rejection

et al. 2010

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BACKGROUND Intensive glycemic control has been shown to positively impact outcomes in an intensive care setting. Whether this practice is beneficial after liver transplantation (LT) is not known. METHODS A retrospective review of patients undergoing LT from 2/02-07/04 was conducted to analyze the association between peri-operative hyperglycemia and outcomes after LT. Covariates included pre-existing diabetes, mean glucose three months pre-LT, need for insulin drip post-LT, mean total glucose during the post-LT hospitalization, age, gender, type of transplant, and MELD score. Outcomes within one year of LT included rejection, infection, re-hospitalization, prolonged ventilation, and patient/graft survival. RESULTS 113 LT and 31 liver-kidney recipients were included. By multivariate logistic regression adjusting for covariates, the rejection rate was significantly lower for patients with postoperative glucose levels < 200 mg/dL (n=114) vs. > 200 mg/dL (n=30) (OR 0.055, 95%CI [0.0154, 0.200], p<0.001). The need for prolonged ventilation was more common in patients with glucose < 200 vs. > 200 mg/dL (OR 4.30, 95%CI [1.284, 14.388], p=0.018). While other outcomes, infection, re-hospitalization, patient/graft survival, were not different among the glucose control groups, rejection was associated with increased re-hospitalizations and infections. CONCLUSION Our data demonstrate an association between immediate post-transplant glycemic control and the development of subsequent rejection. Prospective trials investigating the effects of perioperative glycemic control on outcomes and morbidity after LT are warranted.

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Section: Discussionmentioning

confidence: 56%

“…This cutoff of 200 mg/dL was chosen because it had been found to be significant for kidney transplant rejection previously (11,12) as well as for cardiovascular outcomes (3). In addition, a quartile analysis was performed.…”

Section: Methodsmentioning

confidence: 99%

Posttransplant Hyperglycemia is Associated With Increased Risk of Liver Allograft Rejection

et al. 2010

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“…The early exposure and response of allograft tissue to hyperglycemia may increase the risk of rejection. Acute hyperglycemia may enhance renal ischemic injury, antigen presentation, apoptosis, and increased inflammatory responses in renal transplantation 7 . Several experimental studies have documented that renal ischemic injury in diabetic animals is worse than similar renal ischemic injury in normoglycemic animals.…”

Section: Introductionmentioning

confidence: 99%

Does propofol and isoflurane protect the kidney against ischemia/reperfusion injury during transient hyperglycemia?

Carraretto¹,

Filho²,

Castiglia

et al. 2013

Acta Cir. Bras.

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PURPOSE:To study the effect of isoflurane (Iso) or propofol (Prop) anesthesia on renal ischemia/reperfusion injury (IRI) during transient hyperglycemia. METHODS:Thirty six rats were randomly assigned into six groups of six animals each: PHS (Sham-Prop=1mg.kg CONCLUSIONS:Propofol and isoflurane showed the same level of protection against ischemia/reperfusion injury in the normoglycemic groups. Transient hyperglycemia is associated with an increase in IRI.

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“…There is also increasing recognition that perioperative glycemic control alone impacts outcomes after transplant even in the absence of PTDM, possibly because of its associated risk of ischemia reperfusion and delayed graft function after kidney transplant [53•, 54•]. Graft rejection is also more frequent in kidney transplant recipients with post-operative hyperglycemia, whether or not they have diabetes [55–58]. In a retrospective review of liver and liver-kidney transplant recipients, patients with higher post-operative glucose levels (more than 200 mg/dL) had a higher rejection rate compared to those with glucose levels less than 200 mg/dL [56].…”

Section: Long-term Consequences Of Perioperative Glucose Controlmentioning

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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Association of Hyperglycemia on Allograft Function in the Early Period After Renal Transplantation

Cited by 25 publications

References 8 publications

Posttransplant Hyperglycemia is Associated With Increased Risk of Liver Allograft Rejection

Posttransplant Hyperglycemia is Associated With Increased Risk of Liver Allograft Rejection

Does propofol and isoflurane protect the kidney against ischemia/reperfusion injury during transient hyperglycemia?

Management of the Hospitalized Transplant Patient

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