Effect of intraoperative hyperglycemia during liver transplantation

Background. Intensive blood glucose management has been shown to decrease mortality and infections for intensive care patients. The effect of intraoperative strict glucose control on surgical outcomes, including liver transplantation, has not been well evaluated. Materials and methods. A retrospective review of all adult liver recipients transplanted between January 1, 2004 and July 6, 2006 was performed. Donor and recipient demographics, intraoperative variables, and outcomes were collected. Intraoperative glucose measurements were performed by the anesthesiology team and treated with intravenous insulin bolus or continuous infusion. Patients with strict glycemic control (mean blood glucose < 150 mg/dL) were compared with those with poor control (mean blood glucose < 150 mg/dL). Results. During the study period, a total of 184 patients met criteria for analysis. Recipients with strict glycemic control (n = 60) had a mean glucose of 135 mg/dL compared with 184 mg/dL in the poorly controlled group (n = 124). Other than recipient age (strict versus poor control, 47 +/- 2 y versus 53 +/- 1 y; P < 0.01), both groups had similar donor and recipient characteristics. Although the incidence of most postoperative complications were similar, poor glycemic control was associated with a significantly increased infection rate at 30 d posttransplant (48% versus 30%; P = 0.02), and also an increased 1 y mortality (21.9% versus 8.8%; P = 0.05). Conclusions. Intraoperative hyperglycemia during liver transplantation was associated with an increased risk of postoperative infection and mortality. Strict intraoperative glycemic control, possibly using insulin infusions, may improve outcomes following liver transplantation. (C) 2007 Elsevier Inc. All rights reserved.