New‐onset diabetes mellitus after pediatric liver transplantation

Regelmann, Molly O.; Goldis, Marina; Arnon, Ronen

doi:10.1111/petr.12523

Cited by 14 publications

(8 citation statements)

References 70 publications

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“…The incidence of posttransplant diabetes mellitus (PTDM) is greater among patients with CF. (85) Among the risk factors for PTDM are glucocorticoids, tacrolimus, and to a lesser extent cyclosporine, sirolimus, and everolimus. (86,87) Glucocorticoids impose an insulin resistant state that can unmask preexisting or underlying β cell insulin secretion defects.…”

Section: Glucose Control and Posttransplant Diabetesmentioning

confidence: 99%

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A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

et al. 2019

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Approximately 5%‐10% of patients with cystic fibrosis (CF) will develop advanced liver disease with portal hypertension, representing the third leading cause of death among patients with CF. Cystic fibrosis with advanced liver disease and portal hypertension (CFLD) represents the most significant risk to patient mortality, second only to pulmonary or lung transplant complications in patients with CF. Currently, there is no medical therapy to treat or reverse CFLD. Liver transplantation (LT) in patients with CFLD with portal hypertension confers a significant survival advantage over those who do not receive LT, although the timing in which to optimize this benefit is unclear. Despite the value and efficacy of LT in selected patients with CFLD, established clinical criteria outlining indications and timing for LT as well as disease‐specific transplant considerations are notably absent. The goal of this comprehensive and multidisciplinary report is to present recommendations on the unique CF‐specific pre‐ and post‐LT management issues clinicians should consider and will face.

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Section: Glucose Control and Posttransplant Diabetesmentioning

confidence: 99%

“…The incidence of posttransplant diabetes mellitus (PTDM) is greater among patients with CF . Among the risk factors for PTDM are glucocorticoids, tacrolimus, and to a lesser extent cyclosporine, sirolimus, and everolimus .…”

Section: Postoperative Management In Lt For Cf Patientsmentioning

confidence: 99%

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

et al. 2019

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“…(3,31)} Our analysis supports OGTT as a valuable, and feasible, tool for identifying children at risk of developing clinical diabetes with stressors like corticosteroids, increased calcineurin inhibitor dosing—or other events like significant weight gain or puberty.…”

Section: Discussionmentioning

confidence: 62%

“…(1) In pediatric liver transplant recipients, diabetes prevalence estimates have ranged from 1.2–14.1% depending on the diabetes definition and patient cohort, but existing studies focus on symptomatic diabetes early post-transplant. (2,3) Neither the long-term impact of diabetes, nor the prevalence of pre-diabetes, which includes impaired glucose tolerance (IGT; blood glucose ≥140mg/dL, 2 hours after glucose load) and impaired fasting glucose (IFG; fasting glucose ≥100mg/dL), have been systematically studied in these children. (4,5) In non-transplanted children, glucose intolerance in childhood increases the risk of diabetes, cardiovascular disease, and premature death in adulthood.…”

mentioning

confidence: 99%

Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors

Perito

Lustig

Rosenthal

2017

The Journal of Pediatrics

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Objective To investigate the role of calcineurin-inhibitor exposure and states of insulin resistance—obesity and adolescence—in pre-diabetes after pediatric liver transplant using oral glucose tolerance testing (OGTT), which has not previously been done systematically in these at-risk youths. Study design Cross-sectional study of 81 pediatric liver transplant recipients. Pre-diabetes defined as IGT (glucose ≥140mg/dL at 2hours) or impaired fasting glucose (IFG, ≥100mg/dL). Corrected insulin response calculated as measure of insulin secretion corrected for glucose (CIR30, CIR60, CIR120). Results Subjects were 8.1–30.0 years old and 1.1–24.7 years post-transplant. 44% had pre-diabetes—27% IGT, 14% IFG, and 3% both. IGT was characterized by insulin hypo secretion, with lower CIR60 and CIR120 in IGT than subjects with normal glucose tolerance (NGT). Subjects with tacrolimus trough >6µg/mL at study visit had lower CIR120 than those with trough≤6µg/mL and those off calcineurin-inhibitors. Mean of tacrolimus troughs preceding study visit, years since transplant, and rejection episodes were not significantly associated with lower CIR. CIR suppression by tacrolimus was most pronounced >6 years from transplant. Overweight/obese subjects and adolescents who retained NGT had higher CIR than those who were IGT. Conclusion IGT after pediatric liver transplant is driven by inadequate insulin secretion. It is quite common but not detectable with fasting labs—the screening recommended by current guidelines. Calcineurin-inhibitors suppress insulin secretion in these patients, in a dose-dependent manner. Given the recent focus on long-term outcomes and immunosuppression withdrawal in these children, longitudinal studies are warranted to investigate whether IGT is reversible with calcineurin-inhibitor minimization.

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“…The incidence of diabetes mellitus is approximately 10%, 54 although this condition can be reversible with modifications of immunosuppression regimens, especially by reducing tacrolimus and steroid doses. Patients may present with other glucose abnormalities; in fact, incidence of impaired glucose tolerance that can reach up to 30%.…”

Section: Diabetes Mellitusmentioning

confidence: 99%

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

Bellini¹,

Lauro²,

D’Andrea³

et al. 2022

Exp Clin Transplant

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Pediatric liver transplant is an established life-saving procedure for children with end-stage liver diseases, achieving excellent graft and patient survival but with effects on quality of life and psychological welfare in the long-term. With the natural increase in the number of pediatric transplant patients becoming adults, it is essential to successfully plan and manage issues affecting late outcomes in the vulnerable pediatric transplant population. This study offers an overview of the long-term surgical complications, the consequences of immunosuppression (such as posttransplant diabetes, hypertension, cardiovascular disease, and renal dysfunction), and the infection and malignancy risks. Finally, because quality of life is now an inclusive measurement of patient satisfaction, guidance on how to facilitate the transition to adulthood, empowering transplant recipients, is also provided.

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New‐onset diabetes mellitus after pediatric liver transplantation

Cited by 14 publications

References 70 publications

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

A Multidisciplinary Approach to Pretransplant and Posttransplant Management of Cystic Fibrosis–Associated Liver Disease

Prediabetes in Pediatric Recipients of Liver Transplant: Mechanism and Risk Factors

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

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