Effect of intraoperative hyperglycemia during liver transplantation.
BACKGROUND
Intensive blood glucose management has been shown to decrease mortality and infections for intensive care patients. The effect of intraoperative strict glucose control on surgical outcomes, including liver transplantation, has not been well evaluated.


METHODS
A retrospective review of all adult liver recipients transplanted between January 1, 2004 and July 6, 2006 was performed. Donor and recipient demographics, intraoperative variables, and outcomes were collected. Intraoperative glucose measurements were performed by the anesthesiology team and treated with intravenous insulin bolus or continuous infusion. Patients with strict glycemic control (mean blood glucose <150 mg/dL) were compared with those with poor control (mean blood glucose >or=150 mg/dL).


RESULTS
During the study period, a total of 184 patients met criteria for analysis. Recipients with strict glycemic control (n=60) had a mean glucose of 135 mg/dL compared with 184 mg/dL in the poorly controlled group (n=124). Other than recipient age (strict versus poor control, 47 +/- 2 y versus 53 +/- 1 y; P<0.01), both groups had similar donor and recipient characteristics. Although the incidence of most postoperative complications were similar, poor glycemic control was associated with a significantly increased infection rate at 30 d posttransplant (48% versus 30%; P=0.02), and also an increased 1 y mortality (21.9% versus 8.8%; P=0.05).


CONCLUSIONS
Intraoperative hyperglycemia during liver transplantation was associated with an increased risk of postoperative infection and mortality. Strict intraoperative glycemic control, possibly using insulin infusions, may improve outcomes following liver transplantation.
Ammori
John B
JB
Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109-0331, USA.
Sigakis
Matthew
M
Englesbe
Michael J
MJ
O'Reilly
Michael
M
Pelletier
Shawn J
SJ
D000328:Adult; D001786:Blood Glucose / Q000502:physiology; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods; D008107:Liver Diseases / Q000209:etiology / Q000517:prevention & control; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin