Glycemic control by a glucose management service and infection rates after liver transplantation

Amisha Wallia, Neehar D. Parikh, Eileen O'Shea-Mahler, Kathleen Schmidt, Anthony J. Desantis, Lu Tian, Josh Levitsky, Mark E. Molitch*

*Corresponding author for this work

Research output: Contribution to journalReview article

24 Citations (Scopus)

Abstract

Objective: To present an analysis of glycemic control before and after introduction of a dedicated glucose management service (GMS) and outcomes within 1 year after liver transplantation (LT).Methods: We conducted a retrospective review of patients undergoing LT, who were treated with insulin infusions after LT, before and after introduction of a GMS. Outcome measures within 1 year after LT included graft rejection, infection, prolonged ventilation (>48 hours on a ventilator), and graft survival. A multiple logistic regression was used to examine the relationship between GMS use and outcomes.Results: This study consisted of 73 (35 GMS and 38 non-GMS) organ transplant recipients. The mean perioperative blood glucose level in the GMS group was lower than in the non-GMS group: unadjusted, by 31.1 mg/dL (P =.001); adjusted for pre-insulin drip glucose, age, sex, Model for End-Stage Liver Disease (MELD) score, and type of transplant, by 23.4 mg/dL (P =.020). There were 27 rejection episodes, 48 infections, 26 episodes of prolonged ventilation, and 64 patients with graft survival at 1 year. The infection rate was lower in the GMS group than in the non-GMS group: the unadjusted odds ratio was 0.28 (P =.015); when adjustments were made for pre-insulin drip glucose, pretransplant glucose, age, sex, MELD score, type of transplant, and diabetes status before transplantation, the odds ratio was 0.24 (95% confidence interval, 0.06 to 0.97; P =.045). No significant associations were noted between GMS group and rejection rates, prolonged ventilation, or graft survival.Conclusion: In this study of LT patients, a GMS was associated with improved glycemic control and reduced postoperative infections. Further studies investigating effects of strict glycemic control after LT are warranted.

Original languageEnglish (US)
Pages (from-to)546-551
Number of pages6
JournalEndocrine Practice
Volume17
Issue number4
DOIs
StatePublished - Jul 1 2011

Fingerprint

Liver Transplantation
Glucose
Infection
Graft Survival
Ventilation
End Stage Liver Disease
Insulin
Transplants
Odds Ratio
Graft Rejection
Mechanical Ventilators
Blood Glucose
Transplantation
Logistic Models
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Wallia, Amisha ; Parikh, Neehar D. ; O'Shea-Mahler, Eileen ; Schmidt, Kathleen ; Desantis, Anthony J. ; Tian, Lu ; Levitsky, Josh ; Molitch, Mark E. / Glycemic control by a glucose management service and infection rates after liver transplantation. In: Endocrine Practice. 2011 ; Vol. 17, No. 4. pp. 546-551.
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abstract = "Objective: To present an analysis of glycemic control before and after introduction of a dedicated glucose management service (GMS) and outcomes within 1 year after liver transplantation (LT).Methods: We conducted a retrospective review of patients undergoing LT, who were treated with insulin infusions after LT, before and after introduction of a GMS. Outcome measures within 1 year after LT included graft rejection, infection, prolonged ventilation (>48 hours on a ventilator), and graft survival. A multiple logistic regression was used to examine the relationship between GMS use and outcomes.Results: This study consisted of 73 (35 GMS and 38 non-GMS) organ transplant recipients. The mean perioperative blood glucose level in the GMS group was lower than in the non-GMS group: unadjusted, by 31.1 mg/dL (P =.001); adjusted for pre-insulin drip glucose, age, sex, Model for End-Stage Liver Disease (MELD) score, and type of transplant, by 23.4 mg/dL (P =.020). There were 27 rejection episodes, 48 infections, 26 episodes of prolonged ventilation, and 64 patients with graft survival at 1 year. The infection rate was lower in the GMS group than in the non-GMS group: the unadjusted odds ratio was 0.28 (P =.015); when adjustments were made for pre-insulin drip glucose, pretransplant glucose, age, sex, MELD score, type of transplant, and diabetes status before transplantation, the odds ratio was 0.24 (95{\%} confidence interval, 0.06 to 0.97; P =.045). No significant associations were noted between GMS group and rejection rates, prolonged ventilation, or graft survival.Conclusion: In this study of LT patients, a GMS was associated with improved glycemic control and reduced postoperative infections. Further studies investigating effects of strict glycemic control after LT are warranted.",
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Glycemic control by a glucose management service and infection rates after liver transplantation. / Wallia, Amisha; Parikh, Neehar D.; O'Shea-Mahler, Eileen; Schmidt, Kathleen; Desantis, Anthony J.; Tian, Lu; Levitsky, Josh; Molitch, Mark E.

In: Endocrine Practice, Vol. 17, No. 4, 01.07.2011, p. 546-551.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Glycemic control by a glucose management service and infection rates after liver transplantation

AU - Wallia, Amisha

AU - Parikh, Neehar D.

AU - O'Shea-Mahler, Eileen

AU - Schmidt, Kathleen

AU - Desantis, Anthony J.

AU - Tian, Lu

AU - Levitsky, Josh

AU - Molitch, Mark E.

PY - 2011/7/1

Y1 - 2011/7/1

N2 - Objective: To present an analysis of glycemic control before and after introduction of a dedicated glucose management service (GMS) and outcomes within 1 year after liver transplantation (LT).Methods: We conducted a retrospective review of patients undergoing LT, who were treated with insulin infusions after LT, before and after introduction of a GMS. Outcome measures within 1 year after LT included graft rejection, infection, prolonged ventilation (>48 hours on a ventilator), and graft survival. A multiple logistic regression was used to examine the relationship between GMS use and outcomes.Results: This study consisted of 73 (35 GMS and 38 non-GMS) organ transplant recipients. The mean perioperative blood glucose level in the GMS group was lower than in the non-GMS group: unadjusted, by 31.1 mg/dL (P =.001); adjusted for pre-insulin drip glucose, age, sex, Model for End-Stage Liver Disease (MELD) score, and type of transplant, by 23.4 mg/dL (P =.020). There were 27 rejection episodes, 48 infections, 26 episodes of prolonged ventilation, and 64 patients with graft survival at 1 year. The infection rate was lower in the GMS group than in the non-GMS group: the unadjusted odds ratio was 0.28 (P =.015); when adjustments were made for pre-insulin drip glucose, pretransplant glucose, age, sex, MELD score, type of transplant, and diabetes status before transplantation, the odds ratio was 0.24 (95% confidence interval, 0.06 to 0.97; P =.045). No significant associations were noted between GMS group and rejection rates, prolonged ventilation, or graft survival.Conclusion: In this study of LT patients, a GMS was associated with improved glycemic control and reduced postoperative infections. Further studies investigating effects of strict glycemic control after LT are warranted.

AB - Objective: To present an analysis of glycemic control before and after introduction of a dedicated glucose management service (GMS) and outcomes within 1 year after liver transplantation (LT).Methods: We conducted a retrospective review of patients undergoing LT, who were treated with insulin infusions after LT, before and after introduction of a GMS. Outcome measures within 1 year after LT included graft rejection, infection, prolonged ventilation (>48 hours on a ventilator), and graft survival. A multiple logistic regression was used to examine the relationship between GMS use and outcomes.Results: This study consisted of 73 (35 GMS and 38 non-GMS) organ transplant recipients. The mean perioperative blood glucose level in the GMS group was lower than in the non-GMS group: unadjusted, by 31.1 mg/dL (P =.001); adjusted for pre-insulin drip glucose, age, sex, Model for End-Stage Liver Disease (MELD) score, and type of transplant, by 23.4 mg/dL (P =.020). There were 27 rejection episodes, 48 infections, 26 episodes of prolonged ventilation, and 64 patients with graft survival at 1 year. The infection rate was lower in the GMS group than in the non-GMS group: the unadjusted odds ratio was 0.28 (P =.015); when adjustments were made for pre-insulin drip glucose, pretransplant glucose, age, sex, MELD score, type of transplant, and diabetes status before transplantation, the odds ratio was 0.24 (95% confidence interval, 0.06 to 0.97; P =.045). No significant associations were noted between GMS group and rejection rates, prolonged ventilation, or graft survival.Conclusion: In this study of LT patients, a GMS was associated with improved glycemic control and reduced postoperative infections. Further studies investigating effects of strict glycemic control after LT are warranted.

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