Early peri-operative glycaemic control and allograft rejection in patients with diabetes mellitus: a pilot study.
BACKGROUND
Hyperglycemia alters the inflammatory response to infection and ischemia. We hypothesize that perioperative glycemic control could also influence the risk for allograft rejection.


METHODS
Consecutive patients with established diabetes undergoing their first cadaveric renal transplantation and receiving steroid-sparing immunosuppression were identified (n=50). Records of capillary glucose observations over the first 100 hr following surgery and transplantation variables pertaining to graft function, acute rejection, and postoperative infection were identified and entered into multivariate analysis.


RESULTS
Perioperative glycemic control was associated with an increased incidence of infection and acute rejection. Only 3 of 27 patients (11%) with optimal glycemic control during the 100 hr following surgery (mean<11.2 mmol/L) had rejection episodes compared with 58% of patients with poor control (>11.2 mmol/L). All patients with poor glycemic control experienced postoperative infection.


CONCLUSIONS
This pilot study suggests that hyperglycemia may be associated with an increased risk of both allograft rejection and postoperative infection in patients with diabetes.
Thomas
M C
MC
Renal Unit, The Queen Elizabeth Hospital, Woodville South 5021, Australia. mdorbell@hotmail.com.
Mathew
T H
TH
Russ
G R
GR
Rao
M M
MM
Moran
J
J
D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D003928:Diabetic Nephropathies / Q000097:blood / Q000601:surgery*; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D015994:Incidence; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D016030:Kidney Transplantation; D008875:Middle Aged; D010865:Pilot Projects; D013997:Time Factors; D014184:Transplantation, Homologous
D001786:Blood Glucose