Diabetes Service, Endocrinology and Metabolic Diseases Unit, IRCCS "Cà Granda - Ospedale Maggiore Policlinico" Foundation, and Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
Department of Clinical and Molecular Medicine, "La Sapienza" University, and Diabetes Unit, Sant'Andrea University Hospital, Rome, Italy.
Pharmacol Res. 2019 Mar;141:556-573. doi: 10.1016/j.phrs.2019.01.042. Epub 2019 Jan 25.
Diabetes is a common feature in cirrhotic individuals both before and after liver transplantation and negatively affects prognosis. Certain aetiological agents of chronic liver disease and loss of liver function per se favour the occurrence of pre-transplant diabetes in susceptible individuals, whereas immunosuppressant treatment, changes in lifestyle habits, and donor- and procedure-related factors contribute to diabetes development/persistence after transplantation. Challenges in the management of pre-transplant diabetes include the profound nutritional alterations characterizing cirrhotic individuals and the limitations to the use of drugs with liver metabolism. Special issues in the management of post-transplant diabetes include the diabetogenic potential of immunosuppressant drugs and the increased cardiovascular risk characterizing solid organ transplant survivors. Overall, the pharmacological management of cirrhotic patients undergoing liver transplantation is complicated by the lack of specific guidelines reflecting the paucity of data on the impact of glycaemic control and the safety and efficacy of anti-hyperglycaemic agents in these individuals.
糖尿病是肝移植前后肝硬化患者的常见特征，对预后有负面影响。某些慢性肝病的病因和肝功能丧失本身就有利于易感个体发生移植前糖尿病，而免疫抑制剂治疗、生活方式习惯的改变以及供体和手术相关因素则导致移植后糖尿病的发生/持续存在。移植前糖尿病管理面临的挑战包括肝硬化个体特征性的严重营养改变以及具有肝脏代谢的药物使用受限。移植后糖尿病管理的特殊问题包括免疫抑制剂药物的致糖尿病潜力和实体器官移植幸存者特征性的心血管风险增加。总体而言，由于缺乏反映血糖控制的影响以及这些个体中抗高血糖药物的安全性和有效性的数据有限，因此肝移植的肝硬化患者的药物治疗管理变得复杂。
