title: Association Between Perioperative Hyperglycemia or Glucose Variability and Postoperative Acute Kidney Injury After Liver Transplantation: A Retrospective Observational Study.
abstract: Glucose control can be difficult in the intraoperative and immediate postoperative period of liver transplantation. Hyperglycemia and glucose variability have been associated with acute kidney injury (AKI) in critically ill patients. We performed a retrospective study to test the hypothesis that perioperative glucose levels represented by time-weighted average glucose levels and glucose variability are independently associated with the incidence of postoperative AKI in patients undergoing liver transplantation.
  
  
  
  On the basis of blood glucose levels during liver transplantation and the initial 48 hours postoperatively, adult liver transplant recipients were classified into 4 groups according to their time-weighted average glucose: normoglycemia (80-200 mg/dL), mild hyperglycemia (200-250 mg/dL), moderate hyperglycemia (250-300 mg/dL), and severe hyperglycemia (>300 mg/dL) group. Patients were also classified into quartiles depending on their glucose variability, defined as the standard deviation of glucose measurements. The primary outcome was postoperative AKI.
  
  
  
  AKI after liver transplantation was more common in the patients with greater perioperative glucose variability (first versus third quartile; OR, 2.47 [95%CI, 1.22-5.00], P = .012; first versus fourth quartile; OR, 2.16 [95% CI, 1.05-4.42], P = .035).
  
  
  
  Our study suggests that increased perioperative glucose variability, but not hyperglycemia, is independently associated with increased risk of postoperative AKI in liver transplantation recipients.
authors.affiliation: From the Department of Anesthesiology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seokha
authors.initials: S
authors.lastname: Yoo
authors.forename: Ho-Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Hannah
authors.initials: H
authors.lastname: Lee
authors.forename: Ho-Geol
authors.initials: HG
authors.lastname: Ryu
mesh_terms: D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D016014:Linear Models; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D059035:Perioperative Period; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D001786:Blood Glucose