Insulin Therapy for Postreperfusion Hyperglycemia During Liver Transplantation

Abstract

Introduction: Glycemic control during liver transplantation can be challenging, especially after reperfusion of the liver graft. Numerous confounding factors make it difficult to predict glucose response to insulin during liver transplantation surgery.

Methods: 13-years of data were retrospectively analyzed to determine the relationship between the insulin dose and blood glucose levels in liver transplantation. Patients were divided into two groups according to insulin responsiveness. The probability and degree of responsiveness to insulin were calculated with probit regression analysis and multiple linear regression equation.

Results: Hyperglycemia was more common and severe in the postreperfusion period than in the prereperfusion period. Of 797 insulin administrations, 299 (37.5%) showed insulin resistance. DM patients were more resistant to insulin therapy showing greater 50% effective dose of insulin compared to non-DM patients during postreperfusion period. Reperfusion periods, history of DM, pretreatment glucose level, and sampling interval were determinants of insulin dose-related changes in blood glucose. Assuming a glucose target of 180 mg/dL and a sampling interval of 20 minutes, a simple formula of glycemic control during postreperfusion period was derived as follows: glucose reduction (mg/dL) = 11.4 + 0.4 x insulin dose (IU) – 7.0 x history of DM (negative = 0, positive = 1).

Conclusion: Commonly administered doses of insulin seems mostly inadequate to treat postreperfusion hyperglycemia. The findings of this study will help establish guidelines to treat refractory hyperglycemia during liver transplantation. ------------------------------------- Abbreviations: DM = diabetes mellitus

ED50 = effective dose with 50% probability of responsiveness

ED95 = effective dose with 95% probability of responsiveness