title: Glucose homeostasis in a diabetic patient during liver transplantation: a case report.
abstract: A 66-year-old woman with type C hepatitis had been treated for hepatocellular carcinoma (HCC) with transcatheter arterial embolization and radiofrequency ablation. Liver function worsened gradually to decompensated liver cirrhosis. She had recurrence of HCC and was later admitted to Juntendo University Hospital for living-donor liver transplantation. Although blood glucose was high, she had never been diagnosed with diabetes mellitus. No diabetes-related complications were detected at that time. We started treatment with multiple insulin injections. There is a unique time called the anhepatic phase during liver transplantation during which the liver does not exist in the body. Recent reports show that it is not necessary to administer glucose for patients with normal glucose tolerance during the anhepatic phase since plasma glucose could be maintained at normoglycemia to hyperglycemia (100-150 mg/dl). In our patient, plasma glucose concentration was rather high during the anhepatic phase without glucose administration. We analyzed the levels of blood glucose, insulin and various other hormones during the anhepatic phase. This could be the first report on glucose homeostasis during the anhepatic phase in a diabetic patient.
authors.affiliation: Department of Medicine, Metabolism and Endocrinology, Juntendo University, School of Medicine, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Arakawa
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hirose
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mita
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Shimizu
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Fujitani
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Watada
authors.forename: Ryuzo
authors.initials: R
authors.lastname: Kawamori
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism / Q000502:physiology*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000378:metabolism / Q000601:surgery; D048909:Diabetes Complications / Q000601:surgery*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000378:metabolism; D005260:Female; D006706:Homeostasis / Q000502:physiology*; D006801:Humans; D033162:Incidental Findings; D008113:Liver Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D016031:Liver Transplantation / Q000502:physiology*