Transplant Trial Watch

Hyperglycemia in the Posttransplant Period: NODAT vs Posttransplant Diabetes Mellitus.

Gupta S, Pollack T, et al.

Journal of the Endocrine Society. 2018; 2(11):1314-9.


Aims
To characterize the types of hyperglycemia that occur up to 1 year following liver transplant, and clarify the nomenclature for posttransplant hyperglycemia.

Interventions
Liver transplant recipients enrolled in an RCT comparing moderate (target glucose ~180 mg/dL [10 mmol/L] group) to intensive (target glucose ~140 mg/dL [7.8 mmol/L] group) insulin therapy to determine if patients had preexisting known diabetes, transient hyperglycemia, persistent hyperglycemia, or new-onset diabetes after transplantation (NODAT).

Participants
65 patients with hyperglycemic episodes following initial hospital discharge and up to 1 year following transplant were included in this retrospective study. These patients were divided into three groups (transient hyperglycemia, n=48; NODAT, n=4; persistent hyperglycemia, n=13).

Outcomes
Analysis of 1-year post transplant glycemic follow-up data in these three groups of patients. Data included fasting glucose levels, random glucose levels, and hemoglobin A1c levels that were obtained at routine posttransplant visits.

Follow-up
1 year post transplantation

CET Conclusions
This post-hoc analysis used data from a randomised controlled trial, comparing moderate insulin with intensive insulin in 164 liver transplant recipients to clarify the nomenclature of posttransplant hyperglycemia and to analyse the most common causes of transient hyperglycemia. There were 65 patients who had hyperglycemic episodes following discharge and up to 1 year posttransplant. Of these, 48 patients had transient posttransplant hyperglycemia, 13 patients had persistent hyperglycemia posttransplant up to 1 year and three patients met the criteria for diabetes. Of the 48 patients who had transient posttransplant hyperglycemia, this resolved between 30 days and 1 year posttransplant in 32 patients. Hyperglycemia for these 32 patients was found to be linked to higher than maintenance steroid doses, high tacrolimus doses, infections and rejection. The RCT was previously appraised and includes an expert commentary in the Transplant Library: http://www.transplantlibrary.com/article/27875061?term=wallia

Jadad score
3

Data analysis
Available case analysis

Allocation concealment
No

Quality notes
SCORE BASED ON - Wallia A, Schmidt K, et al. J Clin Endocrinol Metab.; 102:451-459, 2017.

Trial registration
ClinicalTrials.gov - NCT01211730

Funding source
Non-industry funded