Current Topics in TransplantationRenal transplantationGlucose Metabolism and Associated Outcome After Pediatric Liver Transplantation

- Glucose intake increases rapidly after pediatric liver transplantation
- Postoperative glucose intake correlates with graft function
- A daily mean blood sugar level >200 mg/dL is not associated with complications
- Permanent high blood sugar levels are associated with increased morbidity and mortality
- Insulin administration in the early phase after liver transplantation is safe

BackgroundDespite hypoglycemia and hyperglycemia being frequently observed in the early postoperative phase, information on glucose metabolism after pediatric liver transplantation (pLT) is scarce.MethodsThe goal of this retrospective single-center study, which included 46 patients who consecutively underwent 55 liver transplantations, was to gather data on glucose uptake, the prognostic relevance of hyperglycemia, and the safety of insulin administration in patients after pLT.ResultsIn this study population, glucose intake to keep blood sugar levels (BSLs) within the targeted range of 120 to 200 mg/dL (6.7-11.1 mmol/L) increased rapidly over the first few postoperative days and was significantly correlated with graft function. There was no association between a postoperative daily mean BSL >200 mg/dL and specific posttransplant complications (acute rejection, infection, need for retransplantation, and/or death). High postoperative mean 7-day BSLs were associated with poor glucose metabolism and an increase in morbidity and 6-month posttransplant mortality. Hypoglycemia was not observed under insulin administration.ConclusionsWith high BSLs being associated with poor glucose metabolism, it is likely that the critical illness itself, in addition to poor graft function, causes the increase in morbidity and mortality, with hyperglycemia serving as a marker.