Paka P, Lieber SR, Lee RA, Desai CS, Dupuis RE, Barritt AS. Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review. World J Transplant 2018; 8(3): 75-83 [PMID: 29988867 DOI: 10.5500/wjt.v8.i3.75]
Corresponding Author of This Article
Alfred Sidney Barritt, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Campus Box 7584, 130 Mason Farm Road, Chapel Hill, NC 27599, United States. barritt@med.unc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 28, 2018; 8(3): 75-83 Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.75
Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review
Prani Paka, Sarah R Lieber, Ruth-Ann Lee, Chirag S Desai, Robert E Dupuis, Alfred Sidney Barritt
Prani Paka, Robert E Dupuis, Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
Sarah R Lieber, Alfred Sidney Barritt, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
Ruth-Ann Lee, Chirag S Desai, Division of Abdominal Transplant, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, United States
Author contributions: Barritt AS contributed to this paper with conception and design of the study; Paka P, Lieber SR, Lee RA and Barritt AS contributed equally to literature review and analysis; Paka P and Lieber SR also contributed with drafting the transcript and with critical revision; all authors contributed to editing and approving the final draft.
Conflict-of-interest statement: Prani Paka was employed by University of North Carolina (UNC)/GlaxoSmithKline (GSK) as a fellow at the time the article was written (GSK markets the drug Rosiglitazone under the brand name Avandia). GSK is not involved in any part of this review. The authors have no other relevant conflicts to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alfred Sidney Barritt, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Campus Box 7584, 130 Mason Farm Road, Chapel Hill, NC 27599, United States. barritt@med.unc.edu
Telephone: +1-919-9662516 Fax: +1-919-9661700
Received: January 23, 2018 Peer-review started: January 23, 2018 First decision: February 9, 2018 Revised: February 20, 2018 Accepted: April 1, 2018 Article in press: April 1, 2018 Published online: June 28, 2018 Processing time: 154 Days and 11.8 Hours
Abstract
AIM
To investigate the relationship between post-liver transplantation (LT) glycemic control and LT outcomes.
METHODS
A 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.
RESULTS
Three 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.
CONCLUSION
Hyperglycemia 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.
Core tip: Despite the importance of post-liver transplantation (LT) glycemic control, there are no evidence-based guidelines on how to manage hyperglycemia in the post-LT period. The aim of this qualitative systematic review is to determine potential associations between glucose levels post-LT and outcomes such as mortality, graft rejection, infection rate, and other related post-LT outcomes. In addition, we analyzed methods for targeting glycemic control including specific therapeutic regimens or insulin protocols utilized in LT recipients.
