Effect of Insulin Therapy using Hyper-insulinemic Normoglycemic Clamp on Inflammatory Response in Brain Dead Organ Donors

Aljiffry, Murad; Hassanain, Mazen; Schricker, Thomas; Shaheen, Mohamed A.; Nouh, Thamer; Lattermann, Ralph; Salman, Ayat; Wykes, Linda; Metrakos, Peter

doi:10.1055/s-0042-101240

Cited by 10 publications

(7 citation statements)

References 32 publications

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“…HgbA1c (%) Percent pancreata transplanted a COHORT, finding that in addition to normoglycemia, DBDs on high-dose insulin therapies also had increases in anti-inflammatory cytokines and decreases in pro-inflammatory cytokines. 27 Our results demonstrated a significant association between lower insulin dose and pancreas utilization on univariate analysis, but these trends did not remain significant when placed in multivariable models. In addition, graft function was not affected by increasing dosages of insulin in the donor.…”

Section: Pancreas Transplanted Pancreas Not Transplantedcontrasting

confidence: 57%

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Sally

Ellis

Hutchens

et al. 2019

Clinical Transplantation

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Criteria for organ acceptance in brain-dead organ donors remain inconsistent, especially when concerning pancreatic transplants. We sought to examine donor-specific predictors of pancreatic graft use and survival to better guide the selection and management of potential donors. A prospective observational study of all donors from ten organ procurement organizations was conducted from March 2012 to January 2015. Critical care endpoints were collected at 4 standardized time points. Data associated with pancreatic transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. From 1819 donors, 238 (13.1%) pancreata were transplanted, and at a mean follow-up of 192 days, 218 (91.6%) grafts had survived. After regression analysis, donor age (OR = 0.89), HgbA1C (OR = 0.07), and achieving the donor management goal (DMG) for ejection fraction at allocation of ≥50% (OR = 3.29) remained as independent predictors of pancreatic utilization.On regression analysis, graft survival was independently predicted by lower donor age (OR = 0.93) and achieving the DMGs for mean arterial pressure (60-110 mm Hg) and glucose (≤180 mg/dL) at separate time points. These results may help guide the management and selection of potential pancreatic donors after brain death. K E Y W O R D Scritical care, donation after brain death, insulin, organ acceptance, organ procurement

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Section: Pancreas Transplanted Pancreas Not Transplantedcontrasting

confidence: 57%

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Sally

Ellis

Hutchens

et al. 2019

Clinical Transplantation

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“…4 Overall 5-year patient survival comparing patients with mean blood glucose less than or equal to 120 mg/dL to those with a mean blood glucose greater than 120 mg/dL with time along X-axis and survival probability along Y-axis. The log-rank test p = 0.047 homeostasis in donors but improved recipient outcome has been achieved with improved glycemic control in donors [38]. A direct relationship between donor and recipient glucose variability may exist and be an unmeasured confounder within this study.…”

Section: Discussionmentioning

confidence: 74%

Intraoperative glycemic control in patients undergoing Orthotopic liver transplant: a single center prospective randomized study

et al. 2020

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Background: Perioperative hyperglycemia is associated with poor outcomes yet evidence to guide intraoperative goals and treatment modalities during non-cardiac surgery are lacking. End-stage liver disease is associated with altered glucose homeostasis; patients undergoing liver transplantation display huge fluctuations in blood glucose (BG) and represent a population of great interest. Here, we conduct a randomized trial to compare the effects of strict versus conventional glycemic control during orthotopic liver transplant (OLT). Methods: Following approval by the Institutional Review Board of the University of Michigan Medical School and informed consent, 100 adult patients undergoing OLT were recruited. Patients were randomized to either strict (target BG 80-120 mg/dL) or conventional (target BG 180-200 mg/dL) BG control with block randomization for diabetic and nondiabetic patients. The primary outcomes measured were 1-year patient and graft survival assessed on an intention to treat basis. Graft survival is defined as death or needing re-transplant (www.unos.org). Three and 5-year patient and graft survival, infectious and biliary complications were measured as secondary outcomes. Data were examined using univariate methods and Kaplan-Meir survival analysis. A sensitivity analysis was performed to compare patients with a mean BG of ≤120 mg/dL and those > 120 mg/dL regardless of treatment group. Results: There was no statistically significant difference in patient survival between conventional and strict control respectively;1 year, 88% vs 88% (p-0.99), 3 years, 86% vs 84% (p-0.77), 5 years, 82% vs 78. % (p-0.36). Graft survival was not different between conventional and strict control groups at 1 year, 88% vs 84% (p-0.56), 3 years 82% vs 76% (p-0.46), 5 years 78% vs 70% (p-0.362). Conclusion: There was no difference in patient or graft survival between intraoperative strict and conventional glycemic control during OLT. Trial registration: Clinical trial number and registry: www.clinicaltrials.gov NCT00780026. This trial was retrospectively registered on 10/22/2008.

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“…According to the Shanghai First Maternity and Infant Hospital Department of Reproductive and Immunology outpatient statistics, the incidence could reach 27.74% among all RPL patients when compared to the proportion of lymphocyte subsets in RPL women with or without IR. The hyperinsuline micoroglycemic clamp technique is the gold standard in the diagnosis of IR [Aljiffry et al 2016]. Apart from this technique, there is no consensus on the IR standard used.…”

Section: Discussionmentioning

confidence: 99%

Insulin resistance in patients with recurrent pregnancy loss is associated with lymphocyte population aberration

Yan

Bao

Shen

et al. 2017

Systems Biology in Reproductive Medicine

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This study was designed to investigate the relationship of insulin resistance (IR) and cellular immune abnormalities associated with women with recurrent pregnancy loss (RPL). Women with RPL were divided into two groups according to their homeostasis model assessment for IR (HOMA-IR) scores. The IR group received metformin approximately 3 months before pregnancy. The percentage of lymphocyte subsets and other blood biochemical indices were tested. The HOMA-IR and fasting serum insulin levels were related to the percentage of lymphocyte subsets. The women with RPL had higher CD3 and CD3CD4 cell levels while CD56CD16cell levels were lower. A higher likelihood of cellular immune abnormalities was observed. Women with normal lymphocyte subsets had normal pregnancy outcomes. Metformin significantly downregulated CD3 and CD3CD4 cells and improved pregnancy outcomes. IR was associated with cellular immune abnormalities in RPL. The data suggests that metformin affected the immune/inflammatory response, which may regulate the cellular immune balance and improve pregnancy outcomes. Abbreviations RPL: recurrent pregnancy loss; IR insulin resistance; HOMA-IR: homeostasis model assessment for IR.

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Effect of Insulin Therapy using Hyper-insulinemic Normoglycemic Clamp on Inflammatory Response in Brain Dead Organ Donors

Cited by 10 publications

References 32 publications

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Intraoperative glycemic control in patients undergoing Orthotopic liver transplant: a single center prospective randomized study

Insulin resistance in patients with recurrent pregnancy loss is associated with lymphocyte population aberration

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