Intraoperative glycemic control in patients undergoing Orthotopic liver transplant: a single center prospective randomized study

Sathish S Kumar, Shawn J Pelletier, Amy Shanks, Aleda Thompson, Christopher J Sonnenday, Paul Picton, Sathish S Kumar, Shawn J Pelletier, Amy Shanks, Aleda Thompson, Christopher J Sonnenday, Paul Picton

Abstract

Background: Perioperative hyperglycemia is associated with poor outcomes yet evidence to guide intraoperative goals and treatment modalities during non-cardiac surgery are lacking. End-stage liver disease is associated with altered glucose homeostasis; patients undergoing liver transplantation display huge fluctuations in blood glucose (BG) and represent a population of great interest. Here, we conduct a randomized trial to compare the effects of strict versus conventional glycemic control during orthotopic liver transplant (OLT).

Methods: Following approval by the Institutional Review Board of the University of Michigan Medical School and informed consent, 100 adult patients undergoing OLT were recruited. Patients were randomized to either strict (target BG 80-120 mg/dL) or conventional (target BG 180-200 mg/dL) BG control with block randomization for diabetic and nondiabetic patients. The primary outcomes measured were 1-year patient and graft survival assessed on an intention to treat basis. Graft survival is defined as death or needing re-transplant (www.unos.org). Three and 5-year patient and graft survival, infectious and biliary complications were measured as secondary outcomes. Data were examined using univariate methods and Kaplan-Meir survival analysis. A sensitivity analysis was performed to compare patients with a mean BG of ≤120 mg/dL and those > 120 mg/dL regardless of treatment group.

Results: There was no statistically significant difference in patient survival between conventional and strict control respectively;1 year, 88% vs 88% (p-0.99), 3 years, 86% vs 84% (p- 0.77), 5 years, 82% vs 78. % (p-0.36). Graft survival was not different between conventional and strict control groups at 1 year, 88% vs 84% (p-0.56), 3 years 82% vs 76% (p-0.46), 5 years 78% vs 70% (p-0.362).

Conclusion: There was no difference in patient or graft survival between intraoperative strict and conventional glycemic control during OLT.

Trial registration: Clinical trial number and registry: www.clinicaltrials.gov NCT00780026. This trial was retrospectively registered on 10/22/2008.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Consort flow diagram
Fig. 2
Fig. 2
Mean intraoperative blood glucose with 95% confidence intervals for standard and strict glycemic control groups. The vertical dashed line represents the median revascularization time, which was similar in both groups
Fig. 3
Fig. 3
Overall survival for standard and strict glycemic control groups with time along the X-axis and survival probability along the Y-axis. A) Five-year mortality, log- rank test p = 0.490. B) Five-year graft survival log-rank test p = 0.303
Fig. 4
Fig. 4
Overall 5-year patient survival comparing patients with mean blood glucose less than or equal to 120 mg/dL to those with a mean blood glucose greater than 120 mg/dL with time along X-axis and survival probability along Y-axis. The log-rank test p = 0.047

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