Blood glucose regulation during living-donor liver transplant surgery.

Experimental & Clinical Transplantation 2015; 13 Suppl 1: 294-300

Aims
To compare the effects of insulin on blood glucose levels during the dissection, anhepatic and neohepatic phases of living-donor liver transplant (LDLT)

Interventions
Patients were randomized to receive infusion of either 5% dextrose in water, or 5% dextrose in water plus insulin.

Participants
120 ASA I-II patients aged 14-64 years scheduled for LDLT

Outcomes
Measured outcomes were hemoglobin, hematocrit, platelet count, prothrombin time, international normalized ration, potassium, creatine, bilirubin, albumin, model for end-stage Liver disease score, total anesthsia time, total surgical time and number of extra bouts of insulin.

Follow-up
End of surgery

CET Conclusions
This randomised controlled trial of 120 living-donor liver transplant recipients compared the effect of 5% dextrose in water plus insulin infusion versus 5% dextrose in water infusion alone on intraoperative blood glucose levels. Blood glucose levels were measured during the dissection phase, anhepatic and neohepatic phase with the target blood glucose level being 150 mg/dl. If blood glucose levels exceeded the target level an extra bolus of insulin was administered, which happened in 75% of patients in the dextrose plus insulin group versus 5% in dextrose alone group. Patients were allocated to groups using the sealed enveloped technique but there was no description of blinding. Intraoperative blood levels were similar in the dissection phase but significantly different between groups during the anhepatic and neohepatic phases, which suggest that isolated dextrose infusion is superior to dextrose plus insulin for managing intraoperative blood glucose levels.

Jadad score
2

Data analysis
Per protocol analysis

Allocation concealment
Yes

Trial registration
None

Funding source
No funding received