Management of diabetes mellitus in patients undergoing liver transplantation. (March 2019)

• Record Type: Journal Article
• Authors: Grancini, Valeria; Resi, Veronica; Palmieri, Eva; Pugliese, Giuseppe; Orsi, Emanuela
• Is Part Of: Pharmacological research. Volume 141(2019)
• Page Start: 556
• Page End: 573
• Publication Date: 2019-03
• Subjects: DM diabetes mellitus -- NODAT new onset diabetes after transplantation -- FPG fasting plasma glucose -- HbA1c and haemoglobin A1c -- OGTT oral glucose tolerance test -- MELD Model for End-Stage Liver Disease -- NAFLD non-alcoholic fatty liver disease -- FFAs free fatty acids -- mTOR mammalian target of rapamycin -- REE resting energy expenditure -- NASH non-alcoholic steatohepatitis -- SUs sulfonylureas -- SUR1 sulfonylurea receptor 1 -- TDZs thiazolidinediones -- AMPK AMP-activated protein kinase -- GLP-1 glucagon-like peptide 1 -- GIP glucose-mediated insulinotropic polypeptide -- DPP-4 dipeptidyl-peptidase 4 -- GLP-1 RAs GLP-1 receptor agonists -- SGLT2 sodium-glucose cotransporter 2 -- eGFR estimated glomerular filtration rate -- AUC area under the curve -- Cmax maximum serum concentration -- ABCB1 ATP-binding cassette subfamily B member 1 -- CVD cardiovascular disease -- CKD chronic kidney disease; Metformin (PubChem CID: 4091) -- Pioglitazone (PubChem CID: 4829) -- Sitagliptin (PubChem CID: 4369359) -- Linagliptin (PubChem CID: 10096344) -- Exenatide (PubChem CID: 45588096) -- Liraglutide (PubChem CID: 16134956) -- Acarbose (PubChem CID: 444254) -- Dapagliflozin (PubChem CID: 9887712) -- Canagliflozin (PubChem CID: 24812758) -- Empagliflozin (PubChem CID: 11949646); Diabetes mellitus -- Liver transplantation -- Immunosuppressant drugs -- Lifestyle intervention -- Anti-hyperglycaemic drugs; Pharmacology -- Periodicals; Pharmacology -- Periodicals; Research -- Periodicals; Médicaments -- Recherche -- Périodiques; Pharmacologie -- Périodiques; 615.105
• DOI: 10.1016/j.phrs.2019.01.042
• Languages: English
• ISSNs: 1043-6618

Abstract

Graphical abstract: Abstract: Diabetes is a common feature in cirrhotic individuals both before and after liver transplantation and negatively affects prognosis. Certain aetiological agents of chronic liver disease and loss of liver function per se favour the occurrence of pre-transplant diabetes in susceptible individuals, whereas immunosuppressant treatment, changes in lifestyle habits, and donor- and procedure-related factors contribute to diabetes development/persistence after transplantation. Challenges in the management of pre-transplant diabetes include the profound nutritional alterations characterizing cirrhotic individuals and the limitations to the use of drugs with liver metabolism. Special issues in the management of post-transplant diabetes include the diabetogenic potential of immunosuppressant drugs and the increased cardiovascular risk characterizing solid organ transplant survivors. Overall, the pharmacological management of cirrhotic patients undergoing liver transplantation is complicated by the lack of specific guidelines reflecting the paucity of data on the impact of glycaemic control and the safety and efficacy of anti-hyperglycaemic agents in these individuals.