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
To investigate the relationship between post-liver transplantation (LT) glycemic control and LT outcomes.
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.
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.
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.