Paka P, Lieber SR, Lee RA, Desai CS, Dupuis RE, Barritt AS. Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review. World J Transplant 2018; 8(3): 75-83 [PMID: 29988867 DOI: 10.5500/wjt.v8.i3.75]
Corresponding Author of This Article
Alfred Sidney Barritt, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Campus Box 7584, 130 Mason Farm Road, Chapel Hill, NC 27599, United States. barritt@med.unc.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Jun 28, 2018; 8(3): 75-83 Published online Jun 28, 2018. doi: 10.5500/wjt.v8.i3.75
Perioperative glucose management and outcomes in liver transplant recipients: A qualitative systematic review
Prani Paka, Sarah R Lieber, Ruth-Ann Lee, Chirag S Desai, Robert E Dupuis, Alfred Sidney Barritt
Prani Paka, Robert E Dupuis, Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, United States
Sarah R Lieber, Alfred Sidney Barritt, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, United States
Ruth-Ann Lee, Chirag S Desai, Division of Abdominal Transplant, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC 27599, United States
Author contributions: Barritt AS contributed to this paper with conception and design of the study; Paka P, Lieber SR, Lee RA and Barritt AS contributed equally to literature review and analysis; Paka P and Lieber SR also contributed with drafting the transcript and with critical revision; all authors contributed to editing and approving the final draft.
Conflict-of-interest statement: Prani Paka was employed by University of North Carolina (UNC)/GlaxoSmithKline (GSK) as a fellow at the time the article was written (GSK markets the drug Rosiglitazone under the brand name Avandia). GSK is not involved in any part of this review. The authors have no other relevant conflicts to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Alfred Sidney Barritt, MD, Associate Professor, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Campus Box 7584, 130 Mason Farm Road, Chapel Hill, NC 27599, United States. barritt@med.unc.edu
Telephone: +1-919-9662516 Fax: +1-919-9661700
Received: January 23, 2018 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
ARTICLE HIGHLIGHTS
Research background
There are no standard guidelines to properly manage hyperglycemia in the perioperative period of liver transplantation.
Research motivation
Understanding the importance of blood glucose level and proper strategies to manage post-liver transplantation hyperglycemia could help reduce adverse outcomes
Research objectives
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.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
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.
