Published online Jun 14, 2015. doi: 10.3748/wjg.v21.i22.6835
Peer-review started: November 27, 2014
First decision: March 10, 2015
Revised: March 25, 2015
Accepted: April 16, 2015
Article in press: April 17, 2015
Published online: June 14, 2015
Processing time: 203 Days and 21.4 Hours
Diabetogenic traits in patients undergoing liver transplantation (LT) are exacerbated intraoperatively by exogenous causes, such as surgical stress, steroids, blood transfusions, and catecholamines, which lead to intraoperative hyperglycemia. In contrast to the strict glucose control performed in the intensive care unit, no systematic protocol has been developed for glucose management during LT. Intraoperative blood glucose concentrations typically exceed 200 mg/dL in LT, and extreme hyperglycemia (> 300 mg/dL) is common during the neohepatic phase. Only a few retrospective studies have examined the relationship between intraoperative hyperglycemia and post-transplant complications, with reports of infectious complications or mortality. However, no prospective studies have been conducted regarding the influence of intraoperative hyperglycemia in LT on post-transplant outcome. In addition to absolute blood glucose values, the temporal patterns in blood glucose levels during LT may serve as prognostic features. Persistent neohepatic hyperglycemia (without a decline) throughout LT is a useful indicator of early graft dysfunction. Moreover, intraoperative variability in glucose levels may predict the need for reoperation for hemorrhage after LT. Thus, there is an urgent need for guidelines for glucose control in these patients, as well as prospective studies on the impact of glucose control on various post-transplant complications. This report highlights some of the recent studies related to perioperative blood glucose management focused on LT and liver disease.
Core tip: Despite the fact that blood glucose control is essential in critically ill patients, glucose levels are typically not managed effectively in patients undergoing liver transplantation. Currently, there are insufficient data from clinical studies on intraoperative glucose in liver transplantation to establish guidelines for glucose management of these patients. Intraoperative features of blood glucose levels may be related to immediate and deleterious outcomes after liver transplantation. Identification of these associations will help to emphasize the prognostic role of intraoperative glucose, and stimulate the establishment of a standard protocol for intraoperative glucose management in liver transplantation.