Anderson April L, Lewis Daniel A, Steinke Douglas T, Ranjan Dinesh, Smith Kelly M, Clifford Timothy M
University of Kentucky, Lexington, USA.
Prog Transplant. 2009 Dec;19(4):298-303. doi: 10.1177/152692480901900403.
New-onset diabetes after transplantation (NODAT) has been associated with cardiovascular and thrombotic complications, acute rejection, and infection in transplant recipients. NODAT in kidney transplantation is well described; however, data are lacking in liver transplant recipients.
To evaluate the incidence of new-onset diabetes within 6 months postoperatively in adult liver transplant recipients. DESIGN, PARTICIPANTS, SETTING, AND INTERVENTIONS: Patients who underwent a liver transplantation at our institution between January 2004 and December 2005 were retrospectively evaluated. NODAT was defined according to the diagnostic criteria of the American Diabetes Association/World Health Organization, persistent hyperglycemia (serum glucose > or = 200 mg/dL occurring 2 weeks after initial steroid induction and persisting for more than 2 weeks), or the need for hypoglycemic agents upon discharge.
Incidence of NODAT within 6 months after transplantation in patients with poor glycemic control within the first 2 weeks after transplantation, acute rejection episodes, infections, hospital readmissions, and cardiovascular and thrombotic events.
Forty-five patients were evaluated. Within the first 6 months after transplantation, NODAT developed in 11 (24%). Acute rejection, infection, hospital readmissions, cardiovascular events, and thrombotic events did not differ between the groups.
Elevated fasting levels of blood glucose during the first 2 weeks after liver transplantation may be associated with an increased incidence of NODAT and may have predictive value. More studies are needed to determine the effects of recognition and treatment of hyperglycemia in recent transplant recipients.
移植后新发糖尿病（NODAT）与移植受者的心血管和血栓并发症、急性排斥反应及感染有关。肾移植中的NODAT已有充分描述；然而，肝移植受者的数据尚缺乏。
评估成年肝移植受者术后6个月内新发糖尿病的发生率。
设计、参与者、设置和干预措施：对2004年1月至2005年12月在本机构接受肝移植的患者进行回顾性评估。NODAT根据美国糖尿病协会/世界卫生组织的诊断标准定义，即持续性高血糖（初始使用类固醇诱导后2周血清葡萄糖≥200mg/dL且持续超过2周），或出院时需要使用降糖药。
移植后前2周血糖控制不佳的患者在移植后6个月内发生NODAT的发生率、急性排斥反应发作、感染、再次入院以及心血管和血栓事件。
对45例患者进行了评估。移植后的前6个月内，11例（24%）发生了NODAT。两组之间的急性排斥反应、感染、再次入院、心血管事件和血栓事件无差异。
肝移植后前2周空腹血糖水平升高可能与NODAT发生率增加有关，且可能具有预测价值。需要更多研究来确定近期移植受者高血糖的识别和治疗效果。
