Impact of differential glycemic management goals in pre-anhepatic and anhepatic phase on early grafted liver function after liver transplantation: An open-label, randomized, controlled study.

Journal of Clinical Anesthesia 2025; 103: 111807.

Aims
This study aimed to investigate how intraoperative blood glucose parameters affects post-operative outcomes in liver transplant recipients.

Interventions
Participants were randomised to either the less intensive glucose management group (7.8–10 mmol/L) or the more intensive glucose management group (4.5–6.7 mmol/L).

Participants
188 patients scheduled to undergo orthotopic liver transplantation.

Outcomes
The primary endpoint was the incidence of early allograft dysfunction (EAD). The secondary endpoints were glycemic variability (GV), incidence of hyperglycemia/hypoglycemia, renal function, postoperative liver enzyme levels, infection rate post-operation, one-year survival rate, inflammatory indicators, mechanical ventilation time, and ICU and hospital stay days.

Follow-up
1 year post-surgery

CET Conclusions
This single centre open-label RCT investigated the impact of intraoperative blood glucose management on outcomes following liver transplantation. Patients were randomised to either less intensive management (7.8-10 mmol/L) or more intensive management (4.5-6.7 mmol/L) during the pre- and anhepatic phases. Less intensive management was associated with reduced glycaemic variability during the post-reperfusion phase, which resulted in lower incidence of early allograft dysfunction and improved graft survival. This is an interesting study, with strong methodology and clear reporting. Randomisation and allocation concealment are good, and analysis is by intent-to-treat, but it should be noted that there are a higher number of patients with missing primary outcomes in the less intensive arm. Larger multicentre studies would be required to see if these findings can generalise to other patient populations.

Jadad score
3

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
ChiCTR2100045342

Funding source
No funding received