Kaplan Alon, Manela Tslil, Hod Tammy, Ghinea Ronen, Mor Eytan, Tirosh Amit, Tirosh Amir, Shlomai Gadi
Internal Medicine D and the Hypertension Unit, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Tel Aviv Faculty of Medicine, Tel-Aviv University, Tel-Aviv 52621, Israel.
Clin Pract. 2024 Sep 25;14(5):1960-1969. doi: 10.3390/clinpract14050156.
Early post-transplant hyperglycemia (EPTH) is an independent risk factor for hospital readmissions, acute rejection, infections and developing post-transplant diabetes mellitus (PTDM). Close glycemic control is prudent in the early post-transplant period. The management of EPTH was evaluated among a cohort of kidney transplant recipients, who either received routine care (RC) or dedicated endocrine care (DEC).
A retrospective analysis was conducted on kidney transplant recipients from 2019 to 2023. The impact of DEC on post-transplant glycemic control was investigated. Hospitalized patients receiving post-transplant insulin therapy were included. DEC involved at least twice-daily blood glucose (BG) assessment by an endocrinologist, while the RC received usual care. A mixed-model analysis was employed to assess differences in BG trajectories between DEC and RC over an eight-day period. Additionally, various glycemic control metrics were compared, including glucose variability, time-in-range for target BG, rates of hypoglycemia and response to hyperglycemia.
The cohort comprised 113 patients. In the DEC group, 91% had pre-transplant DM compared to 15% in the RC group ( < 0.001). Patients under DEC had higher baseline BG and glycated hemoglobin compared to those under RC ( < 0.001, for both). The DEC group displayed a lower trajectory of BG over time compared to the RC group ( = 0.002). Patients under DEC were more likely to receive insulin if BG measured above 200 mg/dL (66% vs. 46%) and displayed less below-range BG (<110 mg/dL) compared to those under RC (12.9% vs. 23.6%, < 0.001).
Management of EPTH by DEC improves glycemic outcomes in renal transplant recipients.
移植后早期高血糖（EPTH）是医院再入院、急性排斥反应、感染以及发生移植后糖尿病（PTDM）的独立危险因素。在移植后早期进行严格的血糖控制是明智的。本研究在一组肾移植受者中评估了EPTH的管理情况，这些受者分别接受常规护理（RC）或专门的内分泌护理（DEC）。
对2019年至2023年的肾移植受者进行回顾性分析。研究了DEC对移植后血糖控制的影响。纳入接受移植后胰岛素治疗的住院患者。DEC包括内分泌科医生至少每天两次的血糖（BG）评估，而RC接受常规护理。采用混合模型分析评估DEC和RC在八天期间BG轨迹的差异。此外，还比较了各种血糖控制指标，包括血糖变异性、目标BG的达标时间、低血糖发生率和对高血糖的反应。
该队列包括113名患者。在DEC组中，91%的患者移植前患有糖尿病，而RC组为15%（<0.001）。与RC组相比，接受DEC的患者基线BG和糖化血红蛋白更高（两者均<0.001）。与RC组相比，DEC组的BG随时间推移的轨迹更低（=0.002）。与RC组相比，BG测量值高于200 mg/dL时，DEC组患者更有可能接受胰岛素治疗（66%对46%），且低于目标范围的BG（<110 mg/dL）更少（12.9%对23.6%，<0.001）。
通过DEC管理EPTH可改善肾移植受者的血糖结局。
