Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.75
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
There are no standard guidelines to properly manage hyperglycemia in the perioperative period of liver transplantation.
Understanding the importance of blood glucose level and proper strategies to manage post-liver transplantation hyperglycemia could help reduce adverse outcomes
The primary objective was to identify an ideal blood glucose level to achieve in the perioperative period for patients undergoing liver transplantation. In addition, exploring treatment regimens to achieve the target blood glucose can help identify better strategies for the management of these patients in the future.
This is a qualitative systematic review that utilized key search terms to find studies on PubMed and other common databases. The search terms were in relation to liver transplantation and blood glucose level management in the perioperative period.
A total of 14 studies fit the criteria to properly study the objectives. The findings from this qualitative review suggests that blood glucose levels greater than or equal to 150 mg/dL in the perioperative period generally leads to negative post-liver transplantation outcomes. Specifically, there was an increased risk of infections, graft rejection, PTDM, and mortality. Graft survival was not impacted by hyperglycemia and there was an increased risk of acute kidney injury with high glucose variability in the perioperative period.
The findings from the compiled studies in this review suggest a blood glucose level between 120 mg/dL and 150 mg/dL could potentially be an ideal target to manage hyperglycemia post-liver transplantation. In addition, early screening, use of oral agents, and utilizing resources such as a glucose management service could be potential strategies to limit adverse outcomes post-transplantation.
Future studies can validate the findings from this review through a prospective study while implementing some of the strategies discussed in this review to minimize post-liver transplantation outcomes.