Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review

Table 3 Summary of important findings of perioperative glucose control on liver transplant outcomes

Outcome of interest	Important findings	Data sources
Mortality	Mean BG ≥ 150 mg/dL increases mortality Nurse initiated insulin protocol did not impact mortality PTDM influenced glucose levels but did not change mortality	Ammori et al[5] (retrospective study) Keegan et al[17] (retrospective study Linder et al[18] (retrospective study)
Graft rejection	Mean BG > 200 mg/dL increases risk of rejection Although, mean BG were lower with the use of GMS, it did not lead to lower rate of rejection Conflicting evidence exists relating to the development of PTDM and its relation to rejection	Wallia et al[1] (retrospective study) Wallia et al[19] (retrospective study) Linder et al[18] and Trail et al[20] (retrospective studies)
Infection rate	BG ≥ 150 mg/dL is associated with higher infection rate BG ≥ 200 mg/dL increases risk of SSIs Use of GMS led to lower rate of infection Higher BG levels post-LT also led to increased incidence of HCV recurrence No association between BG levels and post-LT CMV infection Development of PTDM did not lead to higher infection rate	Ammori et al[5] (retrospective study) Park et al[27] (retrospective study) Wallia et al[1] (retrospective study) Gelley et al[21] (retrospective study) Linder et al[18] (retrospective study) Trail et al[20] (retrospective study)
Post-transplant diabetes mellitus/new onset diabetes mellitus	Rosiglitazone ± sulfonylurea is a potential option for the management of PTDM Post-LT hyperglycemia is associated with the development of PTDM Insulin use was significantly higher in PTDM patients with inadequate BG	Villanueva et al[22] (prospective study) Linder et al[18] (retrospective study) Alvarez-Sotomayor et al[24] (retrospective study)
Acute kidney injury and graft survival	High glucose variability is associated with post-LT acute kidney injury No association between post-LT BG levels and graft survival	Yoo et al[6] (retrospective study) Wallia et al[1] and Trail et al[20] (retrospective studies)

BG: Blood glucose; PTDM: Post-transplant diabetes mellitus; GMS: Glucose management service; HCV: Hepatitis C virus; LT: Liver transplantation.