Evidence for impaired glucose effectiveness in cirrhotic patients after liver transplantation.
To evaluate the impact of acute and chronic liver disease and single immunosuppression (cyclosporine A [CSA] or FK506) on insulin sensitivity and glucose effectiveness in liver-grafted patients, we performed a frequently sampled intravenous glucose tolerance test (FSIGTT) in nondiabetic patients after orthotopic liver transplantation (OLT) with acute liver failure ([ALF] group, n = 9, with CSA therapy), in patients after OLT with chronic liver disease (CSA group, n = 8; FK506 group, n = 8), and in 9 healthy control subjects. Insulin sensitivity and glucose effectiveness were determined by analyzing glucose and insulin data from the FSIGTT with Bergman's minimal model technique for glucose. The intravenous glucose tolerance index ([KG] ie, the slope of the regression of the logarithm of blood glucose concentration) was not different between the ALF group (2.17 +/- 0.16 min(-1)) and controls (2.29 +/- 0.13 min(-1)), but was lower (P < .05) in both groups with chronic liver disease (CSA group, 1.46 +/- 0.1; FK506 group, 1.61 +/- 0.11 min(-1)) compared with the ALF group (P < .05). A positive relation for the KG and glucose effectiveness was found in all liver-grafted patients and controls. Insulin sensitivity was not different between all liver-grafted patients and controls. The body mass index (BMI) was the overall determinant of insulin sensitivity in all groups. Single immunosuppressive therapy does not impair insulin sensitivity in liver-grafted patients. The lower glucose effectiveness in liver-grafted patients with chronic liver disease but not in patients after ALF points to a defect in the regulation of glucose-mediated glucose uptake in peripheral tissue.
Konrad
T
T
Department of Internal Medicine I, Johann Wolfgang Goethe-University, Frankfurt, Germany.
Steinmüller
T
T
Vicini
P
P
Toffolo
G
G
Grewerus
D
D
Schüller
A
A
Bechstein
W O
WO
Usadel
K H
KH
Cobelli
C
C
Mahon
A
A
Wittmann
W
W
Klar
E
E
Golling
M
M
Neuhaus
P
P
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002784:Cholesterol / Q000097:blood; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D018149:Glucose Intolerance / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000097:blood*; D008103:Liver Cirrhosis / Q000601:surgery*; D017114:Liver Failure, Acute / Q000601:surgery; D016031:Liver Transplantation / Q000276:immunology / Q000502:physiology*; D008297:Male; D008954:Models, Biological; D011183:Postoperative Complications; D012016:Reference Values; D016559:Tacrolimus / Q000627:therapeutic use; D014280:Triglycerides / Q000097:blood
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D007328:Insulin; D014280:Triglycerides; D016572:Cyclosporine; D002784:Cholesterol; D016559:Tacrolimus