Controlling Diabetes After Liver Transplantation

Alvarez-Sotomayor, Diego; Satorres, Carla; Rodríguez-Medina, Beatriz; Herrero, Ignacio; Mata, Manuel de la; Serrano, Trinidad; Rodríguez‐Perálvarez, Manuel; D’Avola, Delia; Lorente, Sara; Rubín, Ángel; Berenguer, Marina

doi:10.1097/tp.0000000000001399

Cited by 15 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another important finding of this study is that all the CV risk factors assessed, except tobacco use, showed a continuous increase during the follow‐up that is evident since the first 6 months after LT. Notably, in accordance with other reports, the control of diabetes, dyslipidemia, and arterial hypertension worsened during the 5 years after LT . Despite the relatively short follow‐up of this series that may not allow us to fully capture the longterm impact of the new‐onset CV risk factors on late CV morbidity, this study revealed that the development of new‐onset CV risk factors may modify the CV risk in the first 5 years after transplantation.…”

Section: Discussionsupporting

confidence: 85%

Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

et al. 2017

Self Cite

View full text Add to dashboard Cite

Cardiovascular (CV) diseases are recognized longterm causes of death after liver transplantation (LT). The objective of this multicenter study was to analyze the prevalence and the evolution of CV risk factors and CV morbidity and mortality in 1819 LT recipients along 5 years after LT. The influence of baseline variables on survival, morbidity, and mortality was studied. There was a continuous and significant increase of the prevalence of all the CV risk factors (except smoking) after LT. CV diseases were the fourth cause of mortality in the 5 years after LT, causing 12% of deaths during the follow-up. Most CV events (39%) occurred in the first year after LT. Preexisting CV risk factors such as age, pre-LT CV events, diabetes, metabolic syndrome, and hyperuricemia, and mycophenolate-free immunosuppressive therapy, increased post-LT CV morbidity and mortality. The development of new-onset CV risk factors after LT, such as dyslipidemia and obesity, independently affected late CV morbidity and mortality. Tacrolimus and steroids increased the risk of posttransplant diabetes, whereas cyclosporine increased the risk of arterial hypertension, dyslipidemia, and metabolic syndrome. In conclusion, CV complications and CV mortality are frequent in LT recipients. Preexisting CV risk factors, immunosuppressive drugs, but also the early new onset of obesity and dyslipidemia after LT play an important role on late CV complications. A strict metabolic control in the immediate post-LT period is advisable for improving CV risk of LT recipients. Liver Transplantation 23 498-509 2017 AASLD.

show abstract

Section: Discussionsupporting

confidence: 85%

Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

et al. 2017

Self Cite

View full text Add to dashboard Cite

show abstract

“…In addition to the previously mentioned outcomes, PTDM has also been associated with higher insulin use in post-LT patients. A cross-sectional study by Alvarez-Sotomayor et al[ 24 ] evaluated 344 patients of whom 141 patients experienced PTDM (157 total but 16 patients did not have HbA1c readings prior to enrollment). Patients with PTDM who had adequate glycemic control (defined as HbA1c < 7%), were significantly less dependent on insulin (39.4%) compared to patients with inadequate glycemic control (80.8%) (OR 6.6, 95%CI: 1.8-24.6, P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…A reasonable target, based on our findings would be a range between 120 mg/dL to 150 mg/dL, given that BG ≥ 150 mg/dL were associated with negative post-LT outcomes. In addition, interventions through nurse-initiated glucose management protocols to achieve specific target BG levels, early screening to identify patients at high-risk for PTDM, and use of oral agents for management of PTDM seem to be a promising approaches to minimize post-LT outcomes[ 17 , 22 , 24 ]. Although not discussed extensively in this review, optimizing immunosuppression regimens may also play an important role as noted by the potential association between basiliximab and pulse steroids with PTDM[ 18 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review

Paka

Lieber

Lee

et al. 2018

WJT

View full text Add to dashboard Cite

AIMTo investigate the relationship between post-liver transplantation (LT) glycemic control and LT outcomes.METHODSA qualitative systematic review on relevant prospective interventions designed to control glucose levels including insulin protocols. Studies investigating an association between glycemic control and post-LT outcomes such as mortality, graft rejection, and infection rate were reviewed. PubMed, EMBASE, and other databases were searched through October 2016.RESULTSThree thousands, six hundreds and ninety-two patients from 14 studies were included. Higher mortality rate was seen when blood glucose (BG) ≥ 150 mg/dL (P = 0.05). BG ≥ 150 mg/dL also led to higher rates of infection. Higher rates of graft rejection were seen at BG > 200 mg/dL (P < 0.001). Mean BG ≥ 200 mg/dL was associated with more infections (P = 0.002). Nurse-initiated protocols and early screening strategies have shown a reduction in negative post-LT outcomes.CONCLUSIONHyperglycemia in the perioperative period is associated with poor post-LT outcomes. Only a few prospective studies have designed interventions aimed at managing post-LT hyperglycemia, post-transplant diabetes mellitus (PTDM) and their impact on post-LT outcomes.

show abstract

“… 5 , 29 , 30 , 36 Tight glucose control, sparing using of corticosteroids, and early referrals to endocrinology should be considered to decrease the risk of NAFLD disease progression in this patient population. 19 , 37 …”

Section: Risk Factors For Nafld In Allograftmentioning

confidence: 99%

Nonalcoholic Fatty Liver Disease after Liver Transplant

Shetty

Giron

Divatia

et al. 2021

Journal of Clinical and Translational Hepatology

View full text Add to dashboard Cite

Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver disease in the world. The rising prevalence of nonalcoholic steatohepatitis (NASH) has led to a 170% increase in NASH cirrhosis as the listing indication for liver transplantation from 2004 to 2013. As of 2018, NASH has overtaken hepatitis C as an indication for liver transplantation in the USA. After liver transplantation, the allograft often develops recurrent NAFLD among patients with known NASH cirrhosis. In addition to recurrent disease, de novo NAFLD has been reported in patients with other indications for liver transplantation. In this review, we will discuss the risk factors associated with recurrent and de novo NAFLD, natural course of the disease, and management strategies after liver transplantation.

show abstract

Controlling Diabetes After Liver Transplantation

Cited by 15 publications

References 32 publications

Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

Cardiovascular morbidity and mortality after liver transplantation: The protective role of mycophenolate mofetil

Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review

Nonalcoholic Fatty Liver Disease after Liver Transplant

Contact Info

Product

Resources

About