New‐onset diabetes after liver transplantation and its impact on complications and patient survival

Lv, Chaoyang; Zhang, Yao; Chen, Xianying; Huang, Xiaowu; Xue, Mengzhou; Sun, Qiqing; Wang, Ting; Liang, Jing; He, Shunmei; Gao, Xin; Zhou, Jian; Yu, Mi; Fan, Jia; Gao, Xin

doi:10.1111/1753-0407.12275

Cited by 58 publications

(80 citation statements)

References 66 publications

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“…After liver transplant, a recent retrospective study of 438 recipients showed that PTDM was associated with increased risk of sepsis, chronic renal fail- press.endocrine.org/journal/edrvure, and decreased survival, compared to those without PTDM (155). Both risk for and outcomes associated with HCV are also impacted by diabetes identified before or after transplant.…”

Section: Outcomes After Other Organ Transplant Groupsmentioning

confidence: 99%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

249

203

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and VA Nebraska-Western Iowa Health Care System (V.S.), Omaha, Nebraska 68105Post-transplant diabetes mellitus (PTDM) is a frequent consequence of solid organ transplantation. PTDM has been associated with greater mortality and increased infections in different transplant groups using different diagnostic criteria. An international consensus panel recommended a consistent set of guidelines in 2003 based on American Diabetes Association glucose criteria but did not exclude the immediate post-transplant hospitalization when many patients receive large doses of corticosteroids. Greater glucose monitoring during all hospitalizations has revealed significant glucose intolerance in the majority of recipients immediately after transplant. As a result, the international consensus panel reviewed its earlier guidelines and recommended delaying screening and diagnosis of PTDM until the recipient is on stable doses of immunosuppression after discharge from initial transplant hospitalization. The group cautioned that whereas hemoglobin A1C has been adopted as a diagnostic criterion by many, it is not reliable as the sole diabetes screening method during the first year after transplant. Risk factors for PTDM include many of the immunosuppressant medications themselves as well as those for type 2 diabetes. The provider managing diabetes and associated dyslipidemia and hypertension after transplant must be careful of the greater risk for drug-drug interactions and infections with immunosuppressant medications. Treatment goals and therapies must consider the greater risk for fluctuating and reduced kidney function, which can cause hypoglycemia. Research is actively focused on strategies to prevent PTDM, but until strategies are found, it is imperative that immunosuppression regimens are chosen based on their evidence to prolong graft survival, not to avoid PTDM. (Endocrine Reviews 37: 37-61, 2016)

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Section: Outcomes After Other Organ Transplant Groupsmentioning

confidence: 99%

Post-Transplant Diabetes Mellitus: Causes, Treatment, and Impact on Outcomes

Shivaswamy

Boerner

Larsen³

2015

Endocrine Reviews

249

203

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“…Glycemic control also has an influence on the clinical course after LT [91] . Good glycolytic activity and glycemic control in the perioperative period will help to ensure adequate liver regeneration [92,93] .…”

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confidence: 99%

Systemic hemodynamics in advanced cirrhosis: Concerns during perioperative period of liver transplantation

Hori

Ogura

Onishi

et al. 2016

WJH

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Advanced liver cirrhosis is usually accompanied by portal hypertension. Long-term portal hypertension results in various vascular alterations. The systemic hemodynamic state in patients with cirrhosis is termed a hyperdynamic state. This peculiar hemodynamic state is characterized by an expanded blood volume, high cardiac output, and low total peripheral resistance. Vascular alterations do not disappear even long after liver transplantation (LT), and recipients with cirrhosis exhibit a persistent systemic hyperdynamic state even after LT. Stability of optimal systemic hemodynamics is indispensable for adequate portal venous flow (PVF) and successful LT, and reliable parameters for optimal systemic hemodynamics and adequate PVF are required. Even a subtle disorder in systemic hemodynamics is precisely indicated by the balance between cardiac output and blood volume. The indocyanine green (ICG) kinetics reflect the patient's functional hepatocytes and effective PVF, and PVF is a major determinant of the ICG elimination Hori T et al . Peculiar hemodynamics in advanced cirrhosis constant (k ICG) in the well-preserved allograft. The k ICG value is useful to set the optimal PVF during living-donor LT and to evaluate adequate PVF after LT. Perioperative management has a large influence on the postoperative course and outcome; therefore, key points and unexpected pitfalls for intensive management are herein summarized. Transplant physicians should fully understand the peculiar systemic hemodynamic behavior in LT recipients with cirrhosis and recognize the critical importance of PVF after LT.

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“…Previous studies have proposed that risk factors for NODALT are associated with specific underlying factors including age, sex, body mass index, viral infection, and pretransplant comorbidities. [21,28] In addition, administration of immunosuppressive agents, including tacrolimus and steroids, which cause insulin resistance and pancreatic β-cell dysfunction, [29,30] may increase the risk of developing NODALT. The following preoperative potential risk factors for NOD were available in the NHIRD records: age, sex, and pretransplantation comorbidities.…”

Section: Discussionmentioning

confidence: 99%