Efficacy of an artificial pancreas device for achieving tight perioperative glycemic control in living donor liver transplantation

Abstract

Intraoperative hyperglycemia during liver transplantation can induce infectious bacterial complications after surgery. The aim of this study was to evaluate the efficacy of the artificial endocrine pancreas in achieving perioperative blood glucose control and preventing infection in patients undergoing living donor liver transplantation (LDLT). We compared 14 patients with an artificial endocrine pancreas device to 14 patients who underwent glycemic control using the sliding scale method with respect to perioperative blood glucose level and postoperative infection. In this study, we aimed to control the perioperative glucose levels consecutively for 24 hours from the induction of anesthesia. The average blood glucose level in the artificial pancreas group was significantly lower than that in the sliding scale group (118 vs. 141 mg/dL, P < 0.05). The postoperative bacterial infection rate of the artificial pancreas group was significantly lower than that of the sliding scale group within one month after LDLT (35.7% vs. 78.6%, P < 0.05). Multiple regression analysis showed non‐application of artificial endocrine pancreas as a significant risk factor of posttransplant infection. The artificial endocrine pancreas enabled the perioperative glucose level to be stably controlled without hypoglycemia. Artificial pancreas may reduce the incidence of postoperative infection after LDLT.

Perioperative intensive glycemic control for liver transplant recipients to prevent surgical site infection: A systematic review and meta‐analysis

“…Two randomized controlled trials 21,22 met the inclusion criteria and are included in a quantitative synthesis. Three retrospective cohort studies [40][41][42] also met the inclusion criteria, however, one of these studies did not present any data regarding SSI, hypoglycemia, allograft rejection or death. 42 The remaining two cohort studies 40,41 Table 1.…”

“…an electronic device (artificial pancreas) analyzed venous blood samples and administered intravenous insulin. 42…”

“…43 In the cohort studies, one study 41 used the CDC definition, another used their own definition 40 and the third study did not report a definition. 42 Other outcome measures in the included studies were graft survival, 21,22 biliary complications, 21,40,42 healthcare associated infections including SSIs, 21,22,[40][41][42] hypoglycemia, 21,22,40 ICU and hospital length of stay and, 21,22 death. 21,22,40 Both trials defined hypoglycemia as a blood glucose level lower than 70 mg/dL.…”

“…Ammori et al 40 found the incidence of SSI in the intensive group was 8.3% (5 group. Using the Newcastle-Ottawa Scale, both cohort studies were assessed to be poor quality, with major areas of concern focussing on comparability, 40,42 outcomes, [40][41][42] and blinding of assessment outcomes [40][41][42] (Table 4).…”

Artificial Organs 2019: A year in review

“…Akihiko Soyama et al of the Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan evaluated the efficacy of the artificial endocrine pancreas in achieving perioperative blood glucose control and preventing infection in patients undergoing living donor liver transplantation (LDLT). They compared 14 patients with an artificial endocrine pancreas device to 14 patients who underwent glycemic control using the sliding scale method with respect to perioperative blood glucose level and postoperative infection.…”