title: Glycemic control by a glucose management service and infection rates after liver transplantation.
abstract: OBJECTIVE
  To present an analysis of glycemic control before and after introduction of a dedicated glucose management service (GMS) and outcomes within 1 year after liver transplantation (LT).
  
  
  METHODS
  We conducted a retrospective review of patients undergoing LT, who were treated with insulin infusions after LT, before and after introduction of a GMS. Outcome measures within 1 year after LT included graft rejection, infection, prolonged ventilation (>48 hours on a ventilator), and graft survival. A multiple logistic regression was used to examine the relationship between GMS use and outcomes.
  
  
  RESULTS
  This study consisted of 73 (35 GMS and 38 non-GMS) organ transplant recipients. The mean perioperative blood glucose level in the GMS group was lower than in the non-GMS group: unadjusted, by 31.1 mg/dL (P = .001); adjusted for pre-insulin drip glucose, age, sex, Model for End-Stage Liver Disease (MELD) score, and type of transplant, by 23.4 mg/dL (P = .020). There were 27 rejection episodes, 48 infections, 26 episodes of prolonged ventilation, and 64 patients with graft survival at 1 year. The infection rate was lower in the GMS group than in the non-GMS group: the unadjusted odds ratio was 0.28 (P = .015); when adjustments were made for pre-insulin drip glucose, pretransplant glucose, age, sex, MELD score, type of transplant, and diabetes status before transplantation, the odds ratio was 0.24 (95% confidence interval, 0.06 to 0.97; P = .045). No significant associations were noted between GMS group and rejection rates, prolonged ventilation, or graft survival.
  
  
  CONCLUSIONS
  In this study of LT patients, a GMS was associated with improved glycemic control and reduced postoperative infections. Further studies investigating effects of strict glycemic control after LT are warranted.
authors.affiliation: Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
authors.forename: Neehar D
authors.initials: ND
authors.lastname: Parikh
authors.forename: Eileen
authors.initials: E
authors.lastname: O'Shea-Mahler
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: DeSantis
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.forename: Josh
authors.initials: J
authors.lastname: Levitsky
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D005260:Female; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007328:Insulin