Characteristics of diabetes after pediatric liver transplant.
Studies of DALT in pediatric recipients describe incidence and risk factors, but diagnostic criteria varied. This study reports characteristics and course of pediatric DALT by established diabetes criteria. Retrospective chart review of pediatric LT recipients evaluated for hyperglycemia (1/1/1997-12/30/2009) and matched, non-diabetic controls. DALT: random blood glucose >11.1 mm, ≥ 2 times, with insulin treatment. DALT diagnosed in 8.0% (24/300) included 7/24 (29.2%) with severe hyperglycemia (>27.7 mm), ketoacidosis in 2/24 (8.3%). At diagnosis, age was ≥ 11 yr old in 22/24 (91.7%); body mass was lean (BMIz -0.2 ± 1.5). Mean blood glucose was 24.6 mm with negative diabetes autoantibodies (19/19) and elevated C-peptide (2.3 nm). DALT onset median 5.0 months included 29.1% >12 months. Insulin duration median 4.6 months included 41.7% >6 months. DALT resolved in 83.3% over 4.9 (0.9-9.1) yr. DALT differed from controls by increased preceding rejections, prednisolone dose, tacrolimus level, and triple immunosuppression (all p < 0.01). In conclusion, pediatric DALT occurred in non-obese adolescents with insulin resistance, distinct from diabetes types 1 or 2. DALT was associated with preceding rejection and increased immunosuppression. Blood glucose monitoring, especially during increased immunosuppression following LT, could allow early diagnosis and reduce morbidity.
Division of Pediatric Endocrinology and Diabetes, Mount Sinai Medical Center, New York, NY 10029, USA.
Fenella
F
Greig
Robert
R
Rapaport
Genna
G
Klein
Gidon
G
Akler
Rachel
R
Annunziato
Tamir
T
Miloh
Ronen
R
Arnon
Sander
S
Florman
Nanda
N
Kerkar
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications / Q000175:diagnosis; D003920:Diabetes Mellitus / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007333:Insulin Resistance; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007166:Immunosuppressive Agents; D007328:Insulin