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Intensified blood glucose treatment in diabetic patients undergoing a liver transplant: impact on graft evolution at 3 months and at 5 years

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Abstract

Purpose

The debate about the impact of intensified hyperglycemia treatment is still ranging. The main objective was to assess whether intensive glycemic control in hospitalized diabetic patients undergoing a liver transplant is associated with a lower rate of graft rejection at 3 months and at 5 years post-transplant.

Methods

Cross-sectional study comparing a cohort of patients undergoing liver transplant in 2010 and 2011, in whom an intensive insulin protocol was applied, with a retrospective group of patients undergoing a liver transplant in 2005 and 2006, in whom a conventional insulin protocol was applied. Both diabetics and non-diabetics were compared. As intensive insulin therapy is applied mainly in diabetic patients, it is expected that, when comparing both periods, the treatment would only benefit those patients.

Results

The logistic regression model showed a statistically significant interaction between the treatment group and the presence of diabetes for the rejection rate 3 months and 5 years post-transplant. At both time points, the intensive insulin treatment group had lower rejection rates in the case of diabetic patients, which did not occur in non-diabetic patients.

Conclusions

Our study shows a decrease in the rate of liver graft rejection in diabetic patients undergoing intensive insulin treatment.

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Abbreviations

BMI:

Body mass index

HCC:

Hepatocellular carcinoma

HCV:

Hepatitis C virus

ICU:

Intensive care unit

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Acknowledgements

Agustín Ramos-Prol and Juan Francisco Merino-Torres are the guarantors of this work and, as such, had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding

The authors received no financial support for this study.

Author information

Authors and Affiliations

  1. Endocrinology and Nutrition Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    A. Ramos-Prol, M. Rubio-Almanza & J. F. Merino-Torres

  2. Unidad Mixta de Investigación de Endocrinología, Nutrición y Dietética, Instituto de Investigación Sanitaria La Fe (Health Research Institute La Fe), Valencia, Spain

    A. Ramos-Prol, M. Rubio-Almanza & J. F. Merino-Torres

  3. Department of Internal Medicine (Endocrinology and Nutrition), Hospital Francesc de Borja, Gandía, Spain

    A. Ramos-Prol

  4. Biostatistics Unit, Health Research Institute La Fe, Valencia, Spain

    D. Hervás-Marín

  5. Liver Transplantation and Hepatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    B. Rodríguez-Medina, M. Berenguer & Á. Moya-Herraiz

Authors
  1. A. Ramos-Prol
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  2. D. Hervás-Marín
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  4. M. Rubio-Almanza
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  6. Á. Moya-Herraiz
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  7. J. F. Merino-Torres
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Contributions

AR-P Principal author, patient visits, testing, data collection. DH-M bioestatistical analysis. BR-M help in search for patients, application of liver transplant protocols. MR-A help in data collection. MB help in coordination, help in search for patients, application of liver transplant protocols. ÁM-H help in search for patients, application of surgery and liver transplant protocols. JFM-T help in coordination, help in analysis and discussion, and help in data collection.

Corresponding author

Correspondence to J. F. Merino-Torres.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required.

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Ramos-Prol, A., Hervás-Marín, D., Rodríguez-Medina, B. et al. Intensified blood glucose treatment in diabetic patients undergoing a liver transplant: impact on graft evolution at 3 months and at 5 years. J Endocrinol Invest 41, 821–829 (2018). https://doi.org/10.1007/s40618-017-0810-z

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  • DOI: https://doi.org/10.1007/s40618-017-0810-z

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