Dynamics of glucose metabolism after liver transplantation: prediabetes as a window of opportunity for patient survival and long‐term kidney function. (15th September 2021)

• Record Type: Journal Article
• Authors: Grottenthaler, Julia M.; Füger, Judith K.; Mahling, Moritz; Königsrainer, Alfred; Malek, Nisar P.; Birkenfeld, Andreas L.; Nadalin, Silvio; Berg, Christoph P.; Heyne, Nils; Guthoff, Martina
• Is Part Of: Transplant international. Volume 34:Number 10(2021)
• Page Start: 1959
• Page End: 1970
• Publication Date: 2021-09-15
• Subjects: prediabetes -- post‐transplantation diabetes mellitus -- liver transplantation -- dynamics -- outcome -- mortality -- kidney function; Transplantation of organs, tissues, etc -- Periodicals; 617.95405
• DOI: 10.1111/tri.13967
• Languages: English
• ISSNs: 0934-0874

Abstract

Summary: Post‐transplantation diabetes mellitus (PTDM) is a relevant complication following liver transplantation with profound impact on morbidity and mortality. To date, little is known about the evolution and dynamics of glucose metabolism and the impact of prediabetes in long‐term follow‐up. To address this issue, all consecutive adult liver transplant recipients ( n = 429) from a European university hospital transplant center between 2007 and 2017 were analyzed retrospectively. In patients without pre‐existing diabetes ( n = 327), we conducted a longitudinal characterization of glucose metabolism. Median follow‐up was 37 [9–64, IQR] months. Median prevalence of prediabetes was 39 [37–39]% and of PTDM 21 [17–22]%. Throughout follow‐up, intra‐individual glucose regulation of patients was highly variable, continuously fluctuating between different states of glucose metabolism (normal glucose tolerance, prediabetes, PTDM). Whereas overall survival and long‐term kidney function of patients with PTDM were significantly lower than that of patients with normal glucose metabolism, prediabetes was not associated with adverse outcome. This study provides new insight into the dynamics and impact of glucose metabolism after liver transplantation. Unlike PTDM, prediabetes is not associated with adverse outcome, providing a window of opportunity for targeted intervention. The results underline the need for constant screening and intervention in posttransplant care of liver allograft recipients. Abstract : Disturbances in glucose metabolism after liver transplantation are frequent and highly dynamic in nature. Unlike posttransplantation diabetes mellitus, prediabetes as a pre‐stage is not associated with impaired outcome and therefore provides a window of opportunity for targeted intervention.